SPECIALIZED PRACTICE CURRICULAR GUIDE for SUBSTANCE USE SOCIAL WORK PRACTICE

2015 EPAS Curricular Guide Resource Series SPECIALIZED PRACTICE CURRICULAR GUIDE for SUBSTANCE USE SOCIAL WORK PRACTICE

2015 EPAS Curricular Guide Resource Series

Published in the United States by the Council on Social Work Education, Inc. All rights reserved. No part of this book may be reproduced or transmitted in any manner what- soever without the prior written permission of the publisher.

ISBN 978-0-87293-201-2

Council on Social Work Education 1701 Duke Street, Suite 200 Alexandria, VA 22314-3457 www.cswe.org Acknowledgments

Funding for this initiative was made possible (in part) by grant no. 6H79TI080816 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

This document was developed through the generous support of the American Academy of Addiction Psychiatry and the Council on Social Work Education.

STEERING COMMITTEE Martha Haley-Bowling CHAIRS Ferrum College Anthony Estreet Tanya Greathouse Morgan State University Metropolitan State University Denver Rebecca Gomez Whitney Harper Our Lady of the Lake University Western Kentucky University Marilyn W. Lewis NATIONAL TASK FORCE Norfolk State University STEERING COMMITTEE Monica Matthieu Saint Louis University Audrey Begun Ohio State University Paul Sacco University of Maryland Manuel Cano University of Texas at San Antonio Shelly Wiechelt University of Maryland, Baltimore County

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NATIONAL TASK FORCE James DiReda Anna Maria College Shauna Acquavita University of Cincinnati Laura Donavon Aurora University Tara Anderson University of St. Thomas Carol S. Drolen University of Alabama Jennifer Anderson University of Wisconsin -Whitewater E. Delores Dungee-Anderson Norfolk State University Joan Blakey Tulane University Malitta Engstrom University of Pennsylvania Joanna (Jody) Brook University of Kansas Susan Michele Esp Boise State University Nancy K. Brown University of South Carolina Daniel Freedman University of South Carolina Daniel L. Buccino Johns Hopkins Hospital Martha Lucia Garcia Marist College Jerry Buie University of Utah Vannessa Gharbi North Carolina Agricultural and Michael Scott Campbell Technical University University of Saint Leo Wendy Grab Kala Chakradhar Wilmington College Murray State University Dorothy S. Greene Coleen Cicale East Tennessee State University Tulane University Ana Guerra Terry Cluse-Tolar Kean University Ohio University Jodi Helbert Shannon Cooper-Sadlo King University Saint Louis University Amber Holbrook Dennis Corbin West Chester University Fayetteville State University David Hussey Grace Creasman Case Western Reserve University Eastern Washington University Nancy Jo Kepple Tracy Cudjoe University of Kansas Morgan State Toula Kourgiantakis Peter Delany University of Toronto George Mason University Michael Lloyd Jennifer Dell Lewis University University of Oklahoma Acknowledgments vii

Michael McGuire Diane Rullo University of North Carolina, Chapel Hill Walden University Tracy McPherson Todd Sage NORC at the University of Chicago University at Buffalo Brian Miller Stephanie Elias Sarabia University of New Hampshire Ramapo College of New Jersey Matthew Mitchell Patricia Tobin Senger Saginaw Valley State University Saint Leo University Kristina Monti Sandra M Sheppard Adelphi University University at Buffalo Lucas Moore Christopher Solomon University of Wisconsin – Madison North Carolina Central University

Orion Mowbray Shelley Steenrod University of Georgia Salem State University Peggy Pittman Munke S. Lala Straussner Murray State University New York University Margaret (Peggy) Murray An-Pyng Sun NIAAA/NIH (Retired) University of Nevada Las Vegas Laura Nissen William Thomas Portland State University Clark Atlanta University Lia Nower Micki Washburn Rutgers University University of Texas- Arlington Vikki O'Connor Lisa E. Watson Keuka College Springfield College Nora Padykula Brooke West Westfield State University Columbia University Rhonda G. Patrick Eveldora Wheeler University of Houston West Liberty University John Paulson Shanika Lavi Wilson University of Southern Indiana University of North Carolina Central University Fanica J. Payne West Virginia University Jessica Yang Winthrop University Regina T. Praetorius University of Texas – Arlington Beth Young Western Carolina University Elaine Rinfrette Edinboro University Marsha Zibalese-Crawford Temple University viii SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

COUNCIL ON SOCIAL Elizabeth Simon WORK EDUCATION Publications Manager Darla Spence Coffey Mumbi Mwaura President and CEO Program Associate, Curricular Resources Jo Ann Coe Regan Vice President of Education Andrea Bediako Former Associate Director of Julie Rhoads Educational Initiatives and Research Director, Education Initiatives and Research Contents

Acknowledgments ...... v Contents ...... ix Preface: Competency-based Education ...... xiii Introduction ...... xvii

Competency 1 Demonstrate Ethical and Professional Behavior ...... 1

Appendix 1A: Orientation Exercise for Professional Responsibility and Lifelong Learning ...... 11 Appendix 1B: Engagement and Assessment Simulation ...... 12 Appendix 1C: Self-Assessment ...... 13

Competency 2 Engage Diversity and Difference in Practice ...... 15

Competency 3 Advance Human Rights and Social, Economic, and Environmental Justice ...... 27

Appendix 3A: Learning Activities on Changing Marijuana Policies and Attitudes ...... 37 Appendix 3B: Field Assignment on Detecting Biases About People Who Use Drugs or Are Alcohol or Drug Dependent ...... 37 Competency 4 Engage in Practice-informed Research and Research-informed Practice ...... 39 Appendix 4A: Theory-informed Research and Practice for Substance Use . . . 47 Appendix 4B: Formulate a Research Question for Substance Use Research . . . 49

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Competency 5 Engage in Policy Practice ...... 53

Competency 6 Engage With Individuals, Families, Groups, Organizations, and Communities ...... 61

Appendix 6A: Motivational Interviewing Practice – Small Group Exercise . . . 67 Appendix 6B: Exploring the Use of Harm Reduction Strategies for Engagement into Treatment ...... 68 Appendix 6C: Recovery Month Activity ...... 69 Appendix 6D: Develop an Outreach Tool for Engaging Community Members into Active Change ...... 70 Appendix 6E: Review of Evidence Based Approaches to Substance Use Disorder Intervention-with a Focus on Engagement ...... 71 Appendix 6F: Group Paper and Presentations on Special Populations . . . . 72 Appendix 6G: Twelve-Step Meeting Observation & Reflection ...... 73

Competency 7 Assess Individuals, Families, Groups, Organizations, and Communities ...... 75

Appendix 7A: SBIRT Assignments ...... 83 Appendix 7B: Engagement Scenarios ...... 84 Appendix 7C: Emilia Sanchez and Social Worker ...... 86 Appendix 7D: Mythbusters Assignment ...... 87 Appendix 7E: Stories on Addiction ...... 89 Appendix 7F: Family-centered Practices in Addictions Group Presentation ...... 90 Appendix 7G: Opioid Book Review ...... 91 Appendix 7H: Policy Assignment ...... 93 Appendix 7 I : Self-assessment of Preparedness for SUD Practice ...... 93 Appendix 7J: Self-help Group Papers ...... 98 Appendix 7K: Summary and Analysis EBP Treatment Paper ...... 99 Appendix 7L: Abstaining Exercise ...... 99 Appendix 7M: Field Activity ...... 101 Contents xi

Competency 8 Intervene With Individuals, Families, Groups, Organizations, and Communities ...... 103

Appendix 8A-1: Identifying and Languaging Feelings ...... 121 Appendix 8A-2: Treatment Planning ...... 122 Appendix 8A-3: Motivational Interviewing Facilitation ...... 123 Appendix 8A-4: SBIRT Skills Practice ...... 123 Appendix 8A-5: CBT Relapse Prevention Practice ...... 124 Appendix 8A-6: Harm Reduction Group Work ...... 124 Appendix 8B-1: Mutual Aid Meeting Assignment ...... 125 Appendix 8B-2: Case Analysis ...... 126 Appendix 8B-3: Group Presentation on a Special Population ...... 127 Appendix 8B-4: Group Facilitation Demonstration ...... 128 Appendix 8B-5: Motivational Interviewing Reflection Paper ...... 129 Appendix 8B-6: Prevention Program Planning ...... 130

Competency 9 Evaluate Practice With Individuals, Families, Groups, Organizations, and Communities ...... 135

Appendix 9A: Lesbian, Gay, Bisexual, or Transgender (LGBT) Older Adults Teaching Module ...... 139

Preface: Competency-based Education

In 2008 CSWE adopted a competency-based education framework for its Educational Policy and Accreditation Standards (EPAS). Competency-based education rests on a shared view of the nature of competence in professional practice. Social work competence is the ability to integrate and apply social work knowledge, values, and skills to practice situations in a purposeful, inten- tional, and professional manner to promote human and community well-being. EPAS recognizes a holistic view of competence; that is, the demonstration of competence is informed by knowledge, values, skills, and cognitive and affective processes that include the social worker’s critical thinking, affective reactions, and exercise of judgment regarding unique practice situations. Overall professional competence is multidimensional and composed of interrelated competencies. An individual social worker’s competence is seen as developmental and dynamic, changing over time in relation to continuous learning (CSWE, 2015, p. 6). Competency-based education is an outcome-oriented approach to curriculum design. The goal of the outcome approach is to ensure that students can demonstrate the integration and application of the competencies in practice. In the EPAS, social work practice competence consists of nine interrelated competencies and component behaviors that consist of knowledge, values, skills, and cognitive and affective processes. Using a curriculum design that begins with the outcomes, expressed as the expected competencies, programs develop the substantive content, pedagogical approach, and educational activities that provide learning opportunities for students to demonstrate the competencies (CSWE, 2015, p. 6).

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SOCIAL WORK COMPETENCIES The 2015 EPAS stipulates nine competencies for the social work profession. These competencies apply to both generalist and specialized practice. The nine social work competencies are listed in the 2015 EPAS on pp. 7–9. Each of the nine social work competencies is followed by a paragraph that describes the dimensions (knowledge, values, skills, and cognitive and affective processes) that make up the competency at the generalist level of practice. This paragraph describes the content that should be reflected in the generalist social work curriculum and represents the underlying content and processes that inform the behaviors. The bullet points under the paragraph descriptions in the EPAS are a set of behaviors that integrate the dimensions of the competency and represent observable components of each competency. The dimensions of the competency inform the behaviors.

FRAMEWORK FOR THE GUIDE The CSWE Commission on Educational Policy (COEP) developed a framework for the development of curricular guides for areas of specialized practice. The task force followed the guidelines for creating substance use competencies and curricular resources listed here:

1) Identification of an area of specialized practice for a specific population, problem area, method of intervention, perspective, or approach to practice in social work (Educational Policy [EP] M2.1).

2) Discussion of how the area of specialized practice builds on generalist practice as described in EP 2.0 (Accreditation Standard [AS] M2.1.1).

3) Identification of the specialized knowledge, values, skills, cognitive and affective processes, and behaviors that extend and enhance the nine social work competencies and prepare students for practice in the area of specialization identified (EP M2.1 and AS M2.1.3).

4) Suggested curriculum content and resources (e.g., readings, multimedia and online resources, modules, assignments, experiential exercises, and class and field activities) for each of the nine social work competencies and any additional competencies identified. The curriculum content and Preface: Competency-based Education xv

resources identified in this guide are not required by accreditation standards and are meant to serve as an optional guide to programs on how to conceptualize trauma-informed social work practice with the nine social work competencies identified in the 2015 EPAS.

5) Identification of the competency dimensions (knowledge, values, skills, and cognitive and affective processes) associated with the course content for each competency.

REFERENCE

Council on Social Work Education. (2015). Educational policy and accreditation standards. Retrieved from https://www.cswe.org/getattachment/Accreditation/ Standards-and-Policies/2015-EPAS/2015EPASandGlossary.pdf.aspx

Introduction

In the United States an estimated 1 in 14 people, 14.5 million, had a substance used disorder in 2017.1 Globally it is estimated that as much as 16% of the population has an alcohol use disorder and as many as 3% have a drug use disorder.2,3 Although this publication is intended to guide specialized practice with individuals and communities affected by substance use, it is important to note that the prevalence of problematic substance use and substance use disorders, as well as the secondary effects (e.g., health, parenting, relational, economic) associated with substance use on individuals and communities, necessitate that all social workers have a minimum competency and knowledge of substance use across the continuum from use to disorder. Social workers will interact with those experiencing a substance use disorder or at risk of a substance use disorder in multiple settings, including child welfare agencies, shelters, skilled nursing facilities, schools, and hospitals. Substance use disorders affect all segments of the population. Furthermore, work with substance use disorders is uniquely influenced by several factors. The prevalence of substance use disorders results in most social workers having exposure to substance use disorders either directly within their family system or indirectly, well before their social work training. In fact, it is

1. Substance Abuse and Mental Health Service Administration. (2017). Reports and detailed tables from the 2017 National Survey on Drug Use and Health. https://www.samhsa.gov/ data/nsduh/reports-detailed-tables-2017-NSDUH 2. World Health Organization. (2017). Global health observatory data: Prevalence of alcohol use disorders. https://www.who.int/gho/substance_abuse/burden/alcohol_prevalence/en/ 3. World Health Organization. (2017). Global health observatory data: Prevalence of drug use disorders. https://www.who.int/gho/substance_abuse/burden/drug_prevalence_text/en/

xvii xviii SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE estimated that one in four children live with at least one adult with a substance use disorder. This means that many social workers will come to this work with their own lived experiences and lived perspective. Ethical and effective practice necessitate that social workers in all settings engage in self-reflection and address internal bias. Additionally, social workers may be drawn to specialized practice with substance use disorders because of their own recovery and lived experiences with substance use disorders. Social workers in recovery have a unique role in contributing to specialized practice. Finally, those with substance use disorders and their families are affected by stigma at micro, mezzo, and macro levels. This stigma affects their ability to address this critical and life-threating health condition, and all social workers regardless of practice area have a responsibility to educate communities and fight to dismantle this crip- pling stigma. Competency for specialized practice with individuals and communities affected by substance use includes the ability to intervene with individuals, families, groups, organizations, and communities in the practice, research, and policy context. Social work education for specialized practice with substance use aims to prepare students through research and best practice standards when working with individuals, families, groups, organizations, and communities. The terms substance use and substance use disorder are used throughout this document. The authors recognize that intervention is necessary at all points of the development of this health condition and are not limited to those with a diagnosis of substance use disorder. Prevention and early intervention are critical components of ethical care. Furthermore, although this guide is targeted toward substance use, we recognize that social workers who spe- cialize in this practice will also work with similar challenges that are treated with similar modalities, such as process disorders, and that people affected by substance use disorders may also be affected by process disorders. Social workers who are competent in specialized practice with substance use recognize the following:

● Substance use disorders are complex health problems. Substance use disorders are complex health conditions that occur on a continuum and require social workers be able to recognize and intervene with evidence-based approaches at multiple points including Introduction xix

use, misuse, abuse, and dependence. Substance use disorders affect people biologically, psychologically, socially, and spiritually, and effective intervention must address all these areas.

● Substance use disorders are often co-occurring with other health and mental health challenges. It is common for substance use disorders to co-occur with other health and mental health disorders. Furthermore, people affected by a substance use disorder are often affected by trauma, and the integration of trauma-informed modalities is an important consideration for intervention. This combination can make intervention complex and requires that social workers have expertise in the treatment of co-occurring disorders.

● Substance use disorders affect families and communities. The impact of substance use disorders goes beyond the person with the diagnosis and affects the families and communities they are part of. Effective intervention necessitates treatment of not just the individual but also the community and family system.

● Treatment is diverse and multifaceted. The complexity of this health condition necessitates that social workers be knowledgeable about and open to multiple treatment options and perspectives. The knowledge base for treatment of problematic substance use is growing rapidly. Social workers must remain knowledgeable about research-based interventions. Social workers have an ethical obligation to provide accurate information on the risks and benefits of all treatment options and to respect the individual’s treatment choices.

● Recovery is possible. Substance use disorders are complex and diverse. Individuals and systems may require intervention across the lifespan. The types of intervention necessary may change based on the progression of the health condition. Although treatment can be difficult and relapse is often part of the process, recovery is possible.

Competency 1 Demonstrate Ethical and Professional Behavior

COMPETENCY DESCRIPTION Social workers working with individuals and communities affected by substance use understand the complexity of the spectrum of substance use disorders (SUDs) and options for recovery. Social workers understand and adhere to professional social work values, ethical standards, and relevant laws and regulations pertaining to confidentiality and privacy in relation to substance use. Social workers recognize the need to differentiate personal and professional values as they relate to substance use and misuse and understand how their personal experiences and affective reactions may influence their professional judgment. Furthermore, they acknowledge their ethical duty to engage in self-reflection, self-regulation, and self-care. Social workers recognize the importance of ongoing professional development activities such as consultation, continuing education, current research, and the ethical use of techno- logical advances as they pertain to substance use and misuse. Social workers use best practice standards and engage in the interprofessional team to guide substance use–related service based in best practice standards.

COMPETENCY BEHAVIORS

● Make ethical decisions by applying the standards of the National Association of Social Workers (NASW) Code of Ethics, comparing state codes and other applicable ethical codes of conduct.

● Demonstrate and role model professional communication in practice situations, including using person-first, nonstigmatizing language and

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treat clients with SUD equitably without applying personal bias, stigma, or discrimination.

● Use self-reflection and self-regulation to manage personal values and biases relative to substance use and misuse.

● Use the most current, evidence-based and culturally informed knowledge to inform SUD practice, research, and policy development and implementation.

● Recognize one’s limitations in skills, knowledge, and abilities and work in cooperation with interdisciplinary SUD providers in the trajectory of care.

CURRICULAR RESOURCES MAPPED TO COMPETENCY DIMENSIONS

Readings Resource Competency Dimension

Addiction Technology Transfer Center Network . (n d. ). . ATTC Knowledge educational packages for opioid use disorders: Social Values workers . https://attcnetwork org/sites/default/files/2018-10/. ATTCEduPackagesOUDsSocialWorkers .pdf Skills Cognitive and Affective Processes

Journal of Social Work Values and Ethics Knowledge Free resource Values http://jswve org/. Cognitive and Affective Processes

National Association of Alcohol and Drug Abuse Counselors . (2016) . Knowledge NAADAC Code of Ethics . https://www .naadac org/code-of-ethics. Values Cognitive and Affective Processes

(continued) Competency 1: Demonstrate Ethical and Professional Behavior 3

Readings (continued)

Resource Competency Dimension

National Association of Social Workers . (2013) . Standards for social Knowledge work practice with clients with substance use disorders . National Values Association of Social Workers . https://www .socialworkers org/LinkClick. . aspx?fileticket=ICxAggMy9CU%3d&portalid=0 Skills Cognitive and Affective Processes

NASW, ASWB, CSWE, and CSWA Standards for Technology in Social Work Knowledge Practice Values https://www .socialworkers org/includes/newIncludes/homepage/PRA-. Cognitive BRO-33617 TechStandards_FINAL_POSTING. .pdf and Affective Processes

SAMHSA . (2019) . Substance abuse confidentiality regulations . Knowledge https://www .samhsa gov/about-us/who-we-are/laws-regulations/. Values confidentiality-regulations-faqs Cognitive and Affective Processes

Straussner, S . L . A ., Senreich, E ,. & Steen, J . T . (2018) . Wounded healers: A Knowledge multistate study of licensed social workers’ behavioral health problems . Values Social Work, 63(2), 125–133 . doi:10 1093/sw/swy012. Cognitive and Affective Processes

Warren, L ., Feit, M . D ., & Wells, J . (2011) . Substance abuse among Knowledge professionals: Limited research on substance-abusing social workers . Values Journal of Human Behavior in the Social Environment, 21, 803–812 .

White, W . (2008) . Alcohol, tobacco, and drug use by addiction Knowledge professionals: Historical reflections and suggested guidelines . Values Alcoholism Treatment Quarterly, 26, 500–535 . Cognitive and Affective Processes

White, W . L ., Evans, A . C ., & Lamb, R . (2009) . Reducing addiction-related Values social stigma . Counselor, 10(6), 52–58 . http://www williamwhitepapers. . Cognitive com/pr/2009ReducingSocialStigma .pdf and Affective Processes 4 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

Learning Activities Resource Competency Dimension

Panel presentation by a broad range of professionals who work with Knowledge people with SUDs. Actively participate and write a 1-page reflection . Values Panelists may include nurses, probation officers, county social workers, clinical social workers, police officers, emergency medical technicians, Cognitive shelter workers, school social workers, medication-assisted treatment and Affective providers, and needle exchange outreach workers . Panelists will identify Processes their roles and responsibilities and describe how interprofessional collaboration is used to provide comprehensive care .

Developing Your Network Knowledge This is an exercise where students work in teams to gather pertinent Cognitive information on the field of addictions . The students are provided a list and Affective of predetermined (1) interprofessional treatment programs (regional, Processes state, and national options are given) and (2) national foundations or associations (e g. ., Association for Addiction Professionals, Substance Abuse and Mental Health Services Administration [SAMHSA], and Centers for Disease Control and Prevention) . The dyads sign up for one resource on each list . Each partnership must then locate the source’s website, become familiar with the scope of services offered, and identify useful information provided by each . Each dyad then presents their findings in class . The debrief of this exercise consists of highlighting what trends in information were evident, what holes existed in the information, the importance of keeping current with referral options, and how valuable it is for new practitioners to develop a network .

Professional Violations and Breaches in Ethics Knowledge A class lecture is provided on the importance of the NASW Code of Values Ethics . The instructor then explains the scope of the state’s professional Cognitive licensing agency . The instructor can pull up the specific licensing board and Affective for their state . All the tabs and functions of the site are explored . The Processes instructor then reviews the list of violations under review . The types of violations evident in the public domain are discussed . Students are then placed in dyads and randomly assigned a specific state . Students are given 30 minutes to review their assigned state’s website for the types of violations currently being adjudicated . Once the time expires, students regroup and share their findings . Themes are reviewed . The instructor then bridges what was found with a discussion of preventative best steps to avoid ethical and professional violations . Competency 1: Demonstrate Ethical and Professional Behavior 5

Media Resource Competency Dimension

Macy, B . (2019) . Dopesick: Dealers, doctors and the drug company that Knowledge addicted America . Back Bay Books . Cognitive and Affective Processes

HealtheKnowledge Knowledge Free clinical supervision foundations course and numerous other Values free and low-cost addiction webinars and online courses . http:// Skills healtheknowledge org/. Cognitive and Affective Processes

SAMHSA Language Matters Series Knowledge ● Part 1: https://www youtube. com/watch?v=f5e2s8iVRDM. Values ● Part 2: https://www youtube. com/watch?v=b4zU3C-kcGY. Skills ● Part 3: https://www youtube. com/watch?v=wBX1Ulu9tMo. Cognitive and Affective ● Part 4: https://www youtube. com/watch?v=B5qdGoBMOfo. Processes

NAADAC Webinar Series Knowledge Multiple free webinars on ethics, self-care, and numerous other SUD- Values related topics . https://www .naadac org/webinars. Skills Cognitive and Affective Processes

Helpful lecture on adult learning theory . Knowledge https://www youtube. com/watch?v=vLoPiHUZbEw. Values See Appendix 1A . Cognitive and Affective Processes

Diverse Podcast Series Knowledge https://www .insocialwork org/. Values Skills Cognitive and Affective Processes 6 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

Assignments Resource Competency Dimension

Research three forms of technology related to SUD treatment and Knowledge recovery. These could be electronic health records, recovery apps, Values social media recovery sites, online support groups, electronic social work services, and so on . Write a 3-page paper (1 page for each form Cognitive of technology) describing the technology and its use in SUD treatment and Affective and recovery, including what it is and how it works; any ethical, Processes confidentiality, or privacy concerns; and whether you would recommend its use . Choose one of these forms of technology and present your findings to the class .

Interview a Person in Long-Term Recovery Values Part 1: Demonstrate and role model professional communication Skills throughout the interview, including using person-first, nonstigmatizing Cognitive language as you discuss their experiences with recovery . and Affective Part 2: Self-reflect on your own experiences, beliefs, values, and biases . Processes Part 3: Write a paper to include what you discovered about recovery (this is not a report identifying who you interviewed or a transcript of the interview), how the interview affected your personal beliefs, values, and biases, and how you can apply this learning experience going forward in social work practice .

Self-Assessment Values Everyone has been personally affected by alcohol or other drugs at Cognitive some time in their lives . This may have been a personal experience and Affective (meaning self) or a friend, family member, or co-worker . Discuss in a Processes typed paper 3–4 pages long how this affected your life . See Appendix 1C .

Career-Long Learning Plan Knowledge Social workers in the SUD field of practice recognize the need for Values continued professional growth and learning after completing their Skills professional education . Prepare a 1- to 2-page plan for career-long learning: (1) Describe your goal or goals upon graduation, (2) identify Cognitive the steps you plan to take to meet that goal, (3) describe how you will and Affective evaluate success, (4) include your reflection on wellness and self-care, Processes and (5) conclude with a summary of goals already achieved and areas for professional growth .

(continued) Competency 1: Demonstrate Ethical and Professional Behavior 7

Assignments (continued)

Resource Competency Dimension

Consumers as Teachers Assignment Knowledge Students are asked to attend two open 12-step meetings . They can attend Values two of the same type or attend two different types . They are instructed to Cognitive listen to how members of the group view treatment and how they view and Affective treatment providers . Students are then asked to write a 1-page synopsis Processes on what they learned from the group members’ stories of engaging with professionals and whether any barriers to group members’ recovery stemmed from professionals’ covert or overt expression of values and biases .

AA and Al-Anon Paper Research Paper Knowledge Attend one Alcoholics Anonymous (AA) and one Al-Anon Family Groups Values (Al-Anon) meeting . Cognitive Each student is to attend one open AA meeting and one open Al-Anon and Affective meeting . Call the AA and Al-Anon numbers in the phone book or check Processes the local newspaper for times and dates of open meetings . If possible, attend an open meeting out of the community in which you live . If asked, explain to the members of the respective meetings that you are attending as a visitor for the requirements of a class in substance abuse that you are taking . You are not expected to make a donation . Do not take notes . Remember, all identifying information is confidential . If you have previously attended an AA meeting, attend a Narcotics Anonymous (NA) meeting or another 12-step meeting and a Nar-Anon Family Groups (Nar-Anon) meeting to complete this assignment . After attending the two meetings, decide whether you think that 12-step meetings are effective treatment options for your clients with substance- related disorders . Describe what you experienced in the meetings that would support your viewpoint . Next, explore the research . Choose at least two studies regarding the effectiveness of 12-step meetings in treating substance-related disorders . Choose at least one study that supports your opinion and at least one study that refutes your opinion . After reviewing the research, did you change your opinion? Would you or would you not refer your clients to a 12-step meeting? How did this exercise alter (if at all) your approach to your social work practice? The paper should be between 6 and 8 pages, which does not include the cover page and references page, follow American Psychological Association (APA, 7th ed .) format, and use 12-point type . 8 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

Field Activities Resource Competency Dimension

Service Learning Skills Partner with a local recovery center to support and participate in a community recovery event .

Interview a SUD Treatment Provider/Agency Resource Binder Knowledge The purpose of this interview is to gather knowledge on community Skills recovery resources for a class resource book and to practice Cognitive professional skills . and Affective Part 1: Interview a SUD treatment provider at an agency in your region . Processes Identify what services and levels of care are available at this agency and how the services are funded, identify any barriers to accessing treatment or funding for treatment, identify any disparities in care, and identify how factors such as stigma affect access to care . Identify strengths and gaps in care provided . Part 2: Have the interviewee complete a feedback form related to your professionalism and ethical behavior during the interview process and interactions at the agency . Part 3: Present to the class resources available at the agency interviewed and provide a handout for classmates to add to their recovery resources binder .

Attend Drug Court Knowledge Observe a session of drug court and notice the collaboration of the Values interprofessional teams in the courtroom . Identify the roles of each Cognitive team member and identify similarities and differences in how they and Affective support the drug court participants’ recovery . Consider the intersection Processes of public health, criminal justice, and social work values . Write a 1-page reflection paper .

Observation Knowledge Observe a clinician interview someone for substance use services . Values What type of questions were asked? Any questions make you feel uncomfortable? What was the referral process like, if there was one? Pay attention to nonverbal cues that the client demonstrates: How did they respond to questions? Did you feel the client’s rights were honored by the professional?

(continued) Competency 1: Demonstrate Ethical and Professional Behavior 9

Field Activities (continued)

Resource Competency Dimension

Abstinence Project Knowledge There are three parts to this assignment . Values 1 . Students will choose a substance or behavior to abstain from for Skills 8 consecutive weeks during the semester (e g. ,. chocolate, sodas, Cognitive Facebook, alcohol, video games, smoking, television, gambling) . and Affective Choose something challenging, but not impossible, to gain a fuller Processes experience of what your clients experience . You will need to be specific (e g. ., all soda pops or just Coca-Cola? all social media or just Facebook?) . 2 . Students will engage in a relapse prevention group concurrently with the abstinence project . The relapse prevention group portion of class will be co-facilitated by two students, except for the first and last, which will be led by the instructor . In the first group each student will share with the group the substance or behavior from which they will abstain . Moving forward, the group facilitators will develop a group plan specific to SUD treatment and relapse prevention and submit the plan to the group dropbox 1 week before they facilitate the group . Dates and co-facilitators will be assigned by the professor . Co-leaders will work together to write a general group note . A group note is only a summary, so it should be limited to 1 page . Do not include the names of participants . The note should contain the following elements and use them as headings for the note . ● Date, time, number of participants ● Purpose of group ● Summary of group process: interventions, dynamics, therapeutic factors, themes, communication patterns, challenging behaviors, strengths, improvements made, and so on ● Evaluation and outcome ● Facilitators 3 . Students will maintain an ongoing recovery journal on their day- to-day experiences as a person in recovery from ______. You will journal a minimum of two entries per week (two separate days) . Journal entries are confidential and should be written in first person . Each entry should be between 200 and 300 words, noting successes, challenges, relapse triggers, obstacles, relapse prevention techniques and support, affective and cognitive processes, and so on .

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Field Activities (continued)

Resource Competency Dimension

Addiction Simulation Exercise and Reflection Paper Knowledge This assignment has two parts . Values First, each student will complete the following exercise to allow him or her Skills to experience some of the physical (thirst being analogous to cravings for Cognitive drugs), social, cognitive, and emotional experiences of addiction . and Affective Processes Protocol Each student will engage in this exercise for 2 full days, 48 consecutive hours . The more strictly one adheres to the guidelines, the more effective the exercise will be . ● Drug . Your drug of choice is ice cubes . You used to be able to “get off” simply on water, but your addiction has progressed way beyond this . You now need specially processed water: ice cubes . ● Craving. Thirst is your craving for the drug ice cubes . Every time you take a drink of any liquid, you must have at least one piece of ice in that liquid . Yes, this will be difficult and will require much planning . This applies to all drinking situations including coffee, water from drinking fountains, cans or bottles of beverages, and even late-night drinks of water after you have awakened from a deep sleep . (Make sure your ice trays are full before going to bed .) ● Legality. Ice is socially unacceptable and illegal . Do not let “regular people” see you or catch you using ice . This applies to friends, family, co-workers, and so on . The only people with whom it is acceptable to be open about your use of ice are other people with an addiction who are participating in this exercise . This will take some creative thinking at home, in restaurants, and other public places . ● Obsession. To simulate the obsession aspect of drug addiction, keep a log every 2 hours (waking hours only) . Obtain a notebook in which you can answer the following questions every 2 hours: Are you thirsty now? Where is your next ice fix coming from? What is your plan to satisfy your cravings? Think ahead! This log will be submitted as part of the assignment . ● Tracks. Acquire and wear something around your wrist (e g. ., ribbon, yarn, string, but not jewelry) . Wear this accessory at all times during the exercise . This bracelet is analogous to needle tracks on the arm of a person who has addiction, so it is socially unacceptable to wear the bracelet . Try your best to keep regular people from seeing the bracelet, because they might ask what it is about, and this would put you in a difficult situation trying to explain it . Remember, you are trying to hide your addiction from regular people . The bracelet will also serve as a reminder that you are participating in this exercise . It will be easy to forget for a few hours, so you will have to be diligent in your participation . Remember, people who are addicted cannot turn off cravings at will . (continued) Competency 1: Demonstrate Ethical and Professional Behavior 11

Field Activities (continued)

Resource Competency Dimension

Second, students will write a critical reflection on their addiction simulation experience . Class readings must be integrated into the reflection papers . The paper is expected to be in APA style, at least 4 full pages and not more than 5 . Complete the following steps in your paper: ● Describe (who, what, where, when, how, as objectively as possible) the experience . ● Examine the experience discussed above, considering the content studied in this course . Choose one issue or theory (don’t forget to cite it properly) to focus on in more detail in light of your past, present, or future practice activities . Consider your gut feelings, your values, and your basic knowledge as you further explicate the concept and what it means for you . ● Articulate learning from the two steps above . Answer the following four questions: 1 . What did I learn (e g. ,. about myself as a social worker, about clients who have addiction, colleagues, communities, agencies)? 2 . How did I learn it (specific experiences in the exercise)? 3 . Why is this learning important for me as a clinical social worker? 4 . What will I do in my future practice, considering this learning? (Courtesy of Dr. Brittany Wilkins, ETSU)

APPENDIX 1A: ORIENTATION EXERCISE FOR PROFESSIONAL RESPONSIBILITY AND LIFELONG LEARNING During the first week of each class, Ihave the class watch a short video on adult learning theory. The video reviews the development of the theory, its aims, and the domains pertinent to andragogic practices. The video link is located in the competency table, "Media: Resources." Then initiate an interactive discussion with the students. Write four questions on a whiteboard, then have the students get up and write their answers to those questions. The questions can be paraphrased but typically are as follows:

● How do you best learn?

● What are your academic pet peeves? 12 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

● What type of class rules would you suggest?

● What contributions will you make to ensure a comfortable learning environment in our class?

Debrief the groups responses and identify common themes. Then merge this exercise into an orientation if how the class will be taught, teaching philosophy, the intent of the learning assignments, and the goals for the course. This exercise can be taught across undergraduate, graduate, and doctoral levels, because it anchors the students to theory, to pedagogic intent, and to the importance of students as emerging professionals being responsible for their own learning.

APPENDIX 1B: ENGAGEMENT AND ASSESSMENT SIMULATION In coordination with the field program, partner with an ample number of field instructors, task instructors, or faculty to function as mock patients. Depending on the size of the class, use dyads or triads, but preferably one student with one mock patient. Preassign the mock-patient's type of diagnosis and presenting problem. Throughout the class, students learn about engagement and assessment techniques. As a class, develop the assessment plan and grading rubric for this assignment. The mock patient is given a copy of the grading rubric and is asked to use the rubric to evaluate their student’s work. The student then self-evaluates using the same rubric.

Critical Pieces of This Exercise

● All students use the same assessment plan. Take an entire class period to facilitate the simulation.

● Mock patients act out various diagnostic features and share their presenting problem with no replications.

● Students must engage the consumer and collect pertinent data, then they must create their written diagnostic formulation.

● All parties are brought back together to debrief their experiences. Mock patients share what was done well and suggestions for Competency 1: Demonstrate Ethical and Professional Behavior 13

improvement. Students share what this was like for them, what they thought they managed well, and what they need to work on.

It is worth noting that although this is a clinical simulation, what naturally emerges in the debrief are the challenges students face regarding their own self-confidence, preparedness, professional communication, and recognition of their own skills (what they already have and what they need to work on).

APPENDIX 1C: SELF-ASSESSMENT Everyone has had a personal experience with alcohol or other drugs at some point and time in their lives. This may have been a personal experience (meaning self) or a friend, family member, or co-worker. Discuss in a typed paper (3–4 pages in length) how this experience affected your life. Here are some areas that you will address in this paper:

● How did this event affect your belief systems? Was it a conflict with your values and personal ethics? Were you trusted, or did you trust the one doing the drug?

● Did this event keep you/user from doing the job you were supposed to do? That could be mother or father, employer, or sibling.

● How did this affect your belief in the importance of personal responsibility?

● How do you compare yourself to others’ drinking or drugging based on this incidence?

● How has your/another person’s self-centeredness or substance use affected your life? Thoughts on substance use?

● How do you deal with the anger and resentment caused by chemical use?

● What do you believe about the need for acceptance of imperfection? Is this a disease? Is this a choice? Give details to back your statements.

Competency 2 Engage Diversity and Difference in Practice

COMPETENCY DESCRIPTION Social workers working with substance use provide a continuum of services extending from prevention to tertiary care, informed by the values of cultural humility, respect for all cultures, ethnicities, and differences, with the understanding that those we serve are the foremost experts of their own lives and experiences supporting their self-determination. This understanding is enhanced through the prism of intersectionality and multicultural humility in a collaborative effort that harmoniously blends evidence-based practices. When working with people engaged in all levels of substance use, a trauma-focused lens that appreciates historical trauma, combined with a strengths perspective, reveals intersections of diversity, multiple life challenges, and internalized oppression. Social workers must be able to understand and apply their knowledge of the historically biased descriptive terms that have been used in the diagnosis and treatment of people with SUDs. This practice has created many barriers: internal ones limiting unconditional positive regard and self-efficacy and external ones preventing access to recovery services and community support. Social workers’ substance use literacy requires continuous focus on using people-first language in order to identify those in recovery as human beings first and their diagnoses or challenges as simply one aspect of their diverse lives. Social workers must be cognizant of their internal biases regarding recovery and those who are challenged by it at the micro, mezzo, and macro levels. This awareness will be an ongoing practice guide for the continuum of substance use services offered and delivered and for education, policy,

15 16 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE and research. Social workers must demonstrate a commitment to diversity, equity, and inclusion when working with individuals and communities affected by substance use.

COMPETENCY BEHAVIORS

● Demonstrate an awareness of how social identity, privilege, and marginalized status can be affected by the systems they are part of at the individual, family, and community levels.

● Articulate how a person’s social location, inclusive of their cultural customs and worldviews, informs their experiences with substance use.

● Practice cultural humility when supporting clients with substance use challenges, which includes a lifelong process of openness, effort, self- awareness, and exploring and learning from similarities and differences.

● Use a strengths-based perspective that facilitates understanding of substance use and its impact in the diverse situations of individuals, families, and communities, driven by their unique stories.

● Consult with supervisors, mentors, and colleagues to enrich self- awareness and self-reflection while practicing multicultural reflexivity to balance the dynamics of power and privilege inherent in the social work position.

CURRICULAR RESOURCES MAPPED TO COMPETENCY DIMENSIONS

Readings Resource Competency Dimension

Amri, S ., & Bemak, F . (2013) . Mental health help-seeking behaviors of Knowledge Muslim immigrants in the United States: Overcoming social stigma and Values cultural mistrust, Journal of Muslim Mental Health, 7(1), 43–63 . Skills Cognitive and Affective Processes

(continued) Competency 2: Engage Diversity and Difference in Practice 17

Readings (continued)

Resource Competency Dimension

Arfken, C . L ., & Ahmed, S . (2016) . Ten years of substance use research Knowledge in Muslim populations: Where do we go from here? Journal of Muslim Values Mental Health, 10(1), 13–24 . Skills

Chang, J . S ., Sorensen, J . L ., Masson, C . L ., Shopshire, M . S ,. Hoffman, K ,. Knowledge McCarty, D ., & Iguchi, M . (2017) . Structural factors affecting Asians Values and Pacific Islanders in community-based substance use treatment: Treatment provider perspectives . Journal of Ethnicity in Substance Skills Abuse, 16, 479–494 . Cognitive and Affective Processes

Doff, J . (2015, May 19) . Native American sobriety circles . The Fix. https:// Knowledge www .thefix .com/content/native-american-sobriety-circles Values Skills Cognitive and Affective Processes

Donlan, W ., Lee, J ., & Paz, J . (2009) . Corazón de Aztlan: Culturally Knowledge competent substance abuse prevention . Journal of Social Work Practice Values in the Addictions, 9, 215–232 . Skills Cognitive and Affective Processes

Green, K . E ., & Feinstein, B . A . (2012) . Substance use in lesbian, gay, and Knowledge bisexual populations: An update on empirical research and implications Values for treatment . Psychology of Addictive Behaviors, 26(2), 265–278 . https://www .ncbi .nlm .nih .gov/pmc/articles/PMC3288601/ Skills

Hodge, D . R ., Zidan, T ., & Hussain, A . (2015) . Modeling the relationships Knowledge between discrimination, depression, substance use, and spirituality with Values Muslims in the United States . Social Work Research, 39(4), 223–233 . Skills Cognitive and Affective Processes

Huang, Y . (2014) . Alcohol consumption among Asian Americans in the Knowledge U .S .: A systematic review . Global Journal of Medicine and Public Health, Values 3(6), 1–9 . Cognitive and Affective Processes

(continued) 18 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

Readings (continued)

Resource Competency Dimension

Jackson, K . F ., & Samuels, G . M . (2011) . Multiracial competence in social Knowledge work: Recommendations for culturally attuned work with multiracial Values people . Social Work, 56, 235–245 .

Krestan, J . (Ed .) . (2000) . Bridges to recovery: addiction, family therapy, Knowledge and multicultural treatment . The Free Press . Values Skills Cognitive and Affective Processes

Lee, T ., Blount, A . J ., & Uwamahoro, O . (2014) . Embracing diversity: Knowledge Treatment and care in addictions counseling . Academic Publishing . Values Skills Cognitive and Affective Processes

Martinez, L . P ., Walter, A . W ., Acevedo, A ., Lopez, L . M ,. & Lundgren, L . Knowledge (2018) . Context matters: Health disparities in substance use disorders Values and treatment . Journal of Social Work Practice in the Addictions, 18, 84–98 . Cognitive and Affective Processes

Mereish, E . H ., & Bradford, J . B . (2014) . Intersecting identities and Knowledge substance use problems: Sexual orientation, gender, race and lifetime Values substance use problems . Journal of Studies on Alcohol and Drugs, 75, 179–188 . https://www .ncbi .nlm .nih .gov/pmc/articles/PMC3893631/ Skills Cognitive and Affective Processes

Reeves, L . J ., Dustman, P . A ,. Holleran, L . K ,. & Marsiglia, F . F . (2008) . Knowledge Creating culturally grounded prevention videos: Defining moments Values in the journey to collaboration . Journal of Social Work Practice in the Addictions, 8(1), 65–94 . Skills Cognitive and Affective Processes

(continued) Competency 2: Engage Diversity and Difference in Practice 19

Readings (continued)

Resource Competency Dimension

Rodrigues, L . M ., Young, C . M ., Neighbors, C ., Tou, R ., & Lu, Q . (2016) . Knowledge Cultural differences and shame in an expressive writing alcohol Values intervention . Journal of Ethnicity in Substance Abuse, 15, 252–267 . https://www .ncbi .nlm .nih .gov/pmc/articles/PMC4929041/ Skills Cognitive and Affective Processes

Sarabia, S ., & Martin, J . (2013) . Aging effects on substance use among Knowledge mid-life women: The moderating influence of race and substance . Values Journal of Social Work Practice in the Addictions, 13, 417–435 . Skills Cognitive and Affective Processes

Steiker, L . K . H ., Casto, F . G ., Kumpfer, K ., Marsiglia, F . F ., Coard, S ., & Knowledge Hopson, L . M . (2008) . A dialogue regarding cultural adaptation of Values interventions . Journal of Social Work Practice in the Addictions, 8(1), 154–162 . Skills

Villarreal, Y . R ., Torres, L . R ., Stotts, A ., Ma, Y ., Sampson, M ., & Bordnick, Knowledge P . S . (2017) . Stress, depression, and drug use among aging Mexican Values American men living in the barrio . Journal of Social Work Practice in the Addictions, 17, 388–401 .

Yun, S . H . & Park, W . (2008) . Clinical characteristics of alcohol drinking Knowledge and acculturation issues faced by Korean immigrants in the United Values States . Journal of Social Work Practice in the Addictions, 8(1), 3–20 . Skills Cognitive and Affective Processes

Media Resource Competency Dimension

American Psychiatric Association . (2019) . Video library APA: Best practice Knowledge highlights for treating diverse patients . https://www .psychiatry . Values org/psychiatrists/cultural-competency/treating-diverse-patient- populations/video-library Skills Cognitive and Affective Processes

(continued) 20 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

Media (continued)

Resource Competency Dimension

Canton, D . (2016) “White poverty privilege?” Poverty and addiction in Knowledge America . https://youtu .be/yCl10l1QF8w Values Cognitive and Affective Processes

Estes, L ., Rosenfelt, S ., & Eyre, C . (1998) . Smoke signals [Motion picture] . Knowledge Miramax . Values Cognitive and Affective Processes

The road to recovery . (2017) . Recovery among diverse populations. Knowledge https://youtu .be/wLDDpAMV6B8 Skills Cognitive and Affective Processes

Torres, I . (2010) . The road to recovery: Embracing diversity. Knowledge http://www .cctv .org/watch-tv/programs/road-recovery-embracing- Values diversity-crossing-barriers-deliver-treatment-everyone Cognitive and Affective Processes

Field Experiences Resource Competency Dimension

Ethics Alive! Knowledge

This field placement assignment helps students familiarize themselves Values with various diversity terms and how their placement agency uses them Cognitive with their staff and clients . They can also begin to work on their own and Affective cultural intelligence and can start a foundation for their own practice . Processes https://www .socialworker com/feature-articles/ethics-articles/ethics-alive. -cultural-competence-awareness-sensitivity-humility-responsiveness/

(continued) Competency 2: Engage Diversity and Difference in Practice 21

Field Experiences (continued)

Resource Competency Dimension

Maschi, R ., & Leibowitz, G . S . (Eds ). . (2018) . Forensic social work: Knowledge Psychosocial and legal issues across diverse populations and settings . Values Springer . Cognitive and Affective Processes

National Association of Social Workers (NASW) . (2015) . Knowledge Standards and indicators for cultural competence in social Values work practice . https://www .socialworkers .org/LinkClick . aspx?fileticket=PonPTDEBrn4%3D&portalid=0 Cognitive and Affective Processes

National Association of Social Workers (NASW) . (2018) . Code of ethics . Knowledge https://www .socialworkers .org/About/Ethics/Code-of-Ethics/Code- Values of-Ethics-English Cognitive and Affective Processes

Puchalski, C . (2006, March) . Spiritual assessment in clinical practice . Knowledge Psychiatric Annals, 36(3), 150–155 . Values Skills Cognitive and Affective Processes

Whitley, R ., & Jarvis, G . E . (2015) . Religious understanding as cultural Knowledge competence: Issues for clinicians . Psychiatric Times . https://www . Values psychiatrictimes .com/special-reports/religious-understanding- cultural-competence-issues-clinicians Cognitive and Affective Processes

Field Experience Exercises Resource Competency Dimension

350 Hour Credentialed Alcoholism & Substance Abuse Counselor Program Knowledge Clinical Internship Guide Values https://www .alfredstate .edu/sites/default/files/downloads/CASAC- Skills CLINICAL-INTERNSHIP .pdf Cognitive and Affective Processes

(continued) 22 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

Field Experience Exercises (continued)

Resource Competency Dimension

Addiction Studies Practicum Manual Knowledge http://my .jessup .edu/psych/wp-content/uploads/sites/40/2017/02/ Values Practicum-manual-master-2016 .pdf . Skills Cognitive and Affective Processes

Assessing Workforce Diversity: A Tool for Mental Health Organizations on Knowledge the Path to Health Equity Values http://www .cars-rp .org/_MHTTC/docs/Assessing-Workforce-Diversity- Cognitive Tool .pdf and Affective Processes

Clinical counseling with an emphasis in addiction: Practicum Manual, Knowledge Guidelines, and Contract Values https://www .ecu .edu/cs-dhs/dars/upload/0117_MS_CC_Practicum_ Skills Manual .pdf . Cognitive and Affective Processes

Substance Abuse Practicum Knowledge https://www .oakton .edu/about/index .php Values Skills Cognitive and Affective Processes

Assignments Resource Competency Dimension

This assignment will help students practice cultural humility by being Knowledge open to the client’s story, history, and cultural and ethnic self-perceptions Values and by exploring the intersectionality of their world and experiences . Skills Interview someone from an underrepresented culture or ethnicity other than your own and create a culturagram of their family and family experiences as well as a genogram . socialworkculturagram weebly. .com/culturagrams .html https://www .genopro .com/genogram/

(continued) Competency 2: Engage Diversity and Difference in Practice 23

Assignments (continued)

Resource Competency Dimension

Assessment and Treatment Planning Case Assignment Knowledge https://optometriceducation .org/wp-content/uploads/2016/10 Values /FINAL-7-19-16-Cultural-Competency-Case-Studies .final_ .pdf Skills Cognitive and Affective Processes

Understanding and Identifying Yourself (Identity) Writing and Values Reflection Paper Skills To effectively practice cultural humility when working with people Cognitive engaged in recovery and other substance use–related services, and Affective social workers must first understand themselves; self-awareness and Processes understanding one’s internal biases are essential . It is also important to be open to exploring and learning similarities and differences of others . For this assignment, students will write a 3- to 5-page paper, briefly introducing themselves by identifying their social identities, privilege, marginalized status, and so on . They will explore their intersectional social identities . In this assignment, students will have the opportunity to familiarize themselves with a variety of diversity-related concepts and terminology that is integral in understanding and implementing the practice behaviors of Competency 2 . Warning: This assignment asks students to explore and discuss some detailed personal information that they may elect not to share, so assignment modification is encouraged . Be sure to include the following: ● Name, where you are from (social location), and family of origin . ● Identify, define, and discuss individual identities and demographics (e g. ., ethnicity, gender identity, sexual orientation, religious and spiritual preference, educational status, socioeconomic status, limitations and disabilities) . ● Define multicultural humility and intersectionality and write about how you would demonstrate understanding of these terms . ● Identify and discuss your implicit biases that may affect how you engage with clients or deliver services . ● Discuss how you will engage in ongoing self-reflection of your identities, to maintain self-awareness and multicultural humility .

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Assignments (continued)

Resource Competency Dimension

Journal Assignment: Case Vignette Knowledge This writing assignment allows students to briefly explore a case example Values and to work on using a strengths-based perspective that facilitates Skills understanding of substance use and its impact on diverse situations for individuals, families, and their unique stories . Students will read through Cognitive the case vignette and answer the questions provided below . and Affective Processes Alyssa is a 15-year-old, African American, cisgender girl . She lives with her mother, who is a single parent, works long hours, and lives in Section 8 housing . Alyssa’s biological father lives locally but is inconsistent in Alyssa life . She and her younger brother (who is 11) have always been very close; Alyssa is often like a second mom to him . This is Alyssa’s sophomore year in high school, and she has recently started hanging out with some of the more popular kids in her school . At one of the first parties she was invited to, many of her peers were drinking alcohol and smoking cannabis, and some of them were snorting Percocet that one of the kids had stolen from his parents . She tried some cannabis and Percocet and has found that she really liked the high . Since then, she has been experimenting with and using a variety of substances: alcohol, pot, inhalants, Percocet, and some cocaine . Her grades have started slipping, and she has become more and more moody and depressed . Her mother has noticed the change in her mood and behavior, but when she confronts her, Alyssa just tells her to leave her alone . Her mom has always tried to give Alyssa privacy and encouraged her to be independent, so she doesn’t want to pry or push too much . However, she is worried that Alyssa’s behavior is becoming increasingly erratic and oppositional . She has stopped spending time with many of her old friends, and she is often mean and sarcastic to family members and her younger brother . Alyssa has started becoming more depressed, and her school counselor recently confronted her about some scars on her arms . Alyssa admitted that she had started cutting herself recently as well . 1 . What multicultural, environmental variables and developmental issues (e g. ., cognitive development, life stage, social context) are affecting Alyssa’s substance use? Explain . 2 . Describe Alyssa’s intersectional self and explain . 3 . What developmental issues or multicultural variables (e g. ., cognitive development, life stage, social context) may affect Alyssa’s recovery? 4 . What interventions would you use to address Alyssa’s issues? What would you do first? Competency 2: Engage Diversity and Difference in Practice 25

Learning Activities Resource Competency Dimension

Circles of My Multicultural Self Knowledge This in-class exercise explores different perceptions of identity and how Values implicit bias can cause harm . Skills http://www .edchange .org/multicultural/activities/circlesofself_ Cognitive handout .html and Affective Processes

Ontario Resource Group . (2010), pp . 32–33 . Knowledge The Ontario Resource Group on Gambling, Ethnicity and Culture (2010, p . 11) . Values https://www .greo .ca/Modules/EvidenceCentre/files/Young Skills %20et%20al(2010)The_treatment_and_prevention_of_PG Cognitive _in_Ontario .pdf and Affective Processes

Ontario Resource Group on Gambling, Ethnicity and Culture . (2010, Knowledge March) . A guide for counselors working with problem gambling clients Values from ethno-cultural communities . Skills http://www .problemgambling .ca/EN/Documents/GuideforCounsellors WorkingWithProblemGamblingClientsfromEthno_ Cognitive culturalCommunities .p and Affective Processes

Van Wormer, K ., & Davis, D . R . (2018) Addiction treatment: A strengths Knowledge perspective (4th ed ). . Cengage . Values Skills Cognitive and Affective Processes

Competency 3 Advance Human Rights and Social, Economic, and Environmental Justice

COMPETENCY DESCRIPTION Social workers working with substance use understand that there are biological, psychological, historical, cultural, economic, and environmental components that contribute to SUDs. Social workers understand that barriers are erected out of an unconscious bias or conscious desire to subjugate disenfranchised individuals, families, groups, and communities based on disability, income, ethnic, racial, or immigrant status, or sexual orientation and gender identity expression. Social workers intervene at multiple systemic levels to empower vulnerable people and their surrounding systems, including prisons and mental health and medical settings, and recognize that there are multiple ways into and out of SUDs that do not include moral deficits. Social workers promote social and economic justice while also reducing a range of injustices, including limited affordability and accessibility to treatment and prevention services, punitive drug enforcement policies and differential sentencing practices, and discrimination against people who use drugs. Substance use and addiction can be the consequences of multilevel social determinants of health that shape risk and protective factors for developing SUDs, as well as the resources available. Certain individuals, families, communities, and groups are disproportionately affected by substance use due to racism, sexism, trauma, economic injustice, and complex global systems of capitalism, finance, and war.

27 28 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

COMPETENCY BEHAVIORS

● Demonstrate awareness of the economic and political drivers of substance use and SUDs that are fueled by oppression of disenfranchised and marginalized groups.

● Intervene to promote and transform current systems to those that include a culture of recovery, social justice, and equity at the social service, public health, and criminal justice levels through community, tribal, national, and global policy interventions.

● Address substance use on multiple levels, including globally, and understand how colonialization, imperialism, oppression, and community, historical, and intergenerational traumas promote oppressive practice.

● Value self-determination in advocating for people assigned to the criminal justice system, rather than the health system, as diversion programs apply systematic bias in who receives treatment versus who goes to jail.

CURRICULAR RESOURCES MAPPED TO COMPETENCY DIMENSIONS

Readings Resource Competency Dimension

Beckett, K ., Nyrop, K ., & Pfingst, L . (2006) . Race, drugs, and policing: Knowledge Understanding disparities in drug delivery arrests . Criminology, 44(1), Values 105–137 . Skills

Bowen, E . A ., & Walton, Q . L . (2015) . Disparities and the social determinants Knowledge of mental health and addictions: Opportunities for a multifaceted social Values work response . Health & Social Work, 40(3), e59–e65 . Cognitive and Affective Processes

Burtle, A . (2010–2013) . What is structural violence? http://www . Knowledge structuralviolence .org/structural-violence/ Values Skills

(continued) Competency 3: Advance Human Rights and Social, Economic, and Environmental Justice 29

Readings (continued)

Resource Competency Dimension

Daly, C . (2018, October 23) . The world’s war on drugs has failed yet again . Knowledge Vice. https://www vice. .com/en_us/article/a3ppbz/the-worlds-war- Skills on-drugs-has-failed-yet-again Cognitive and Affective Processes

Davis, A . (2019) . Historical knowledge of oppression and racial attitudes of Knowledge social work students . Journal of Social Work Education, 55(1), 160–175 . Values https://doi .org/10 .1080/10437797 .2018 .1498419 Skills Cognitive and Affective Processes

Drug Policy Alliance . Latinx and the drug war. http://www .drugpolicy . Knowledge org/latinxs-and-drug-war Values

Drug Policy Alliance . (2017, July) . It’s time for the U .S . to decriminalize Knowledge drug use and possession . DRA Report. http://www .drugpolicy .org/ Values resource/its-time-us-decriminalize-drug-use-and-possession Cognitive and Affective Processes

Ferrer, B ., & Connolly, J . M . (2018) . Racial inequities in drug arrests: Knowledge Treatment in lieu of and after incarceration . American Journal of Public Values Health, 108(8), 968–969 . doi:10 .2105/AJPH .2018 .304575 Skills Cognitive and Affective Processes

Hart, C . (2014, January 29) . How the myth of the “negro cocaine fiend” Knowledge helped shape American drug policy . The Nation. https://www . Values thenation .com/article/how-myth-negro-cocaine-fiend-helped-shape- american-drug-policy/ Cognitive and Affective Processes

Iguchi, M . Y ., Bell, J ., Ramchand, R . N ., & Fain, T . (2005) . How criminal Knowledge system racial disparities may translate into health disparities . Journal of Values Healthcare for the Poor and Underserved, 16 (4), 48–56 .

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Readings (continued)

Resource Competency Dimension

International Network of People who Use Drugs (INPUD) . (2015) . The Knowledge human rights of and demands from people who use drugs. http://inpud . Values net/rights_and_demands_2015 .pdf

International Network of People who Use Drugs (INPUD) . (2018, Knowledge November 1) . INPUD statement: International Drug Users’ Day. http:// Skills www .inpud .net/sites/default/files/International%20Drug%20 Users%20Day%20One%20Pager%202018%20Final .pdf

Lopez, G . (2017, April 4) . When a drug epidemic’s victims are White: Knowledge How racial bias and segregation molded a gentler rhetorical Values response to the opioid crisis . Vox . https://www vox. .com/ identities/2017/4/4/15098746/opioid-heroin-epidemic-race Cognitive and Affective Processes

Mitchell, O ., & Caudy, M . S . (2015) . Examining racial disparities in drug Knowledge arrests . Justice Quarterly, 32(2), 288–313 . Skills

Mooney, A . C ., Giannella, E ,. Glymour, M . M ., Neilands, T . B ., Morris, M . D ., Knowledge Tulsky, J ., & Sudhinaraset, M . (2018) . Racial/ethnic disparities in arrests Values for drug possession after California Proposition 47, 2011–2016 . American Journal of Public Health, 108, 987–993 . Skills

Moore, L . D ., & Elkavic, A . (2008) . Who’s using and who’s doing time: Knowledge Incarceration, the war on drugs, and public health . American Journal of Values Public Health, 98(suppl 1), S176–S180 . https://www .ncbi .nlm .nih .gov/ pmc/articles/PMC2374804/

Neuspiel, D . (1996) . Racism and perinatal addiction. Ethnicity & Disease, 6, Knowledge 47–55 . Values Skills

Neuspiel, D . R ., Zingman, T . M ., Templeton, V . H ., DiStabile, P ., & Drucker, Knowledge E . (1993) . Custody of cocaine-exposed newborns: Determinants of Values discharge decisions . American Journal of Public Health, 83, 1726–1729 . Skills

(continued) Competency 3: Advance Human Rights and Social, Economic, and Environmental Justice 31

Readings (continued)

Resource Competency Dimension

Roberts, S . C ., & Nuru-Jeter, A . (2012) . Universal screening for alcohol and Knowledge drug use and racial disparities in child protective services reporting . Values Journal of Behavioral Health Services and Research, 39 (1), 3–16 . Cognitive and Affective Processes

Sanders-Phillips, K ., Kliewer, W ., Tirmazi, T ., Nebbitt, V ., Carter, T ., & Key, Knowledge H . (2014) . Perceived racial discrimination, drug use, and psychological Skills distress in African American youth: A pathway to child health disparities . Journal of Social Issues, 70(2), 279–297 . Cognitive and Affective Processes

Watson, C . (2015) . When “Just Say No” is not enough: Teaching harm Knowledge reduction . The New Social Worker . https://www .socialworker .com/ Values extras/social-work-month-2015/when-just-say-no-is-not-enough- teaching-harm-reduction/

Learning Activities Resource Competency Dimension

Debate Knowledge Discuss the Anti–Drug Abuse Bill of 1988 in a debate format . One Skills side makes the argument that the bill is needed for the greater good because of the societal effect of the cocaine “epidemic” in the United States . The opposing side takes the position that the bill is unfair to people of color, who typically smoke crack rather than use powder cocaine . https://www .govinfo .gov/content/pkg/STATUTE-102/pdf/STATUTE -102-Pg4181 .pdf Students will understand the Anti–Drug Abuse Bill of 1988 and be able to explain how disparities in sentencing, when the result is highly correlated with race, violate the principle of social justice . Students will learn how to understand the social context and the characteristics of a bill .

Small Group Discussion Knowledge Currently, most states in the United States have decriminalized marijuana Skills use to some extent . Discuss the following question within small groups Cognitive with the expectation that each group will share highlights from their and Affective conversation within the larger class-wide discussion . Processes

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Learning Activities (continued)

Resource Competency Dimension

Specifically, when the laws change, how do we respond to people who currently hold criminal records, are under probation, or are in jail or prison for marijuana-related crimes? To put this into context, marijuana crimes typically account for about 30% of drug arrests, which means a large proportion of people have been affected by activities that are no longer viewed in the same way (i e. ., the same activity that once was a felony shifts to a misdemeanor) . See Appendix 3A . Discuss state-level policy changes related to marijuana use and sales and identify policy preferences for social control, regulation, and social allowance . Students will be able to critically identify the benefits and challenges that come with any policy decision . Reflect on how personal preferences, experiences, and one’s understanding may bias reactions and subsequent responses to changing policies and attitudes .

Panel Presentation Knowledge Social work students will break into groups to present a panel discussion Values of the interconnections of drug use and dependence, oppression, and Skills human rights violations among Native Americans, by examining historical cultural trauma . Cognitive and Affective Skewes, M . C ., & Blume, A . W . (2019) . Understanding the link between Processes racial trauma and substance use among American Indians . American Psychologist, 74(1), 88–100 . https://psycnet .apa org/. record/2019-01033-008 Students will be able to identify how historical trauma and oppression of Native Americans are related to drug use and dependence . Students value social justice for groups that historically have been oppressed because of their cultural group . Students will gain practice in developing a presentation and presenting information about a topic . Social workers must become sensitized to the oppression of Native Americans and how people from other groups benefit from their oppression .

Group Assignment Knowledge Assign each group a drug and have them trace major policy initiatives around Skills that drug . Have them identify the people most affected by the policy and Cognitive what implications this has had or will have for that population . Students will and Affective determine whether the policy is accomplishing the original intent and what Processes changes could be made to increase the policy’s effectiveness . Students will understand how policies, although well intentioned, can adversely affect certain populations . Students will be able to critically analyze a policy and understand the impact it has on people . Students must be able to identify stakeholders and what they need to effectively carry out their parts .

(continued) Competency 3: Advance Human Rights and Social, Economic, and Environmental Justice 33

Learning Activities (continued)

Resource Competency Dimension

Group Assignment Knowledge As a member of a group, students will pick a harm reduction strategy Values and teach the class about this strategy . They should identify the pros and Skills cons of the strategy and review the necessary components to implement this strategy and possible barriers to implementing it in their state . Their information should be shared with the class . Students will gain knowledge of a variety of harm reduction strategies . Students must be able to identify their biases that provide barriers to harm reduction treatment . Students will be able to critically analyze harm reduction strategies and discuss the pros and cons of implementing a strategy in their state .

Presentation Knowledge Create small piles of cards with the names of different ethnic groups Values (e g. ., African American, Asian American, Caucasian, Latinx) . Add Skills different categories for gender and mix them up with the ethnic groups . Then create a pile of various income levels and a pile with various Cognitive other circumstances (e g. ,. disability, diabetes, HIV/AIDS, felony criminal and Affective history, Ivy League education, 9th grade education, misdemeanor Processes criminal record) . Next, create a pile for different levels of drug use (e g. ., recreational use, drug dependent, occasional use, no drug use) . Finally, create a pile for different types of support (e g. ,. no support, estranged from family, a few friends with similar backgrounds and support, full family support) . Students will choose a card from each pile and journal how this constellation of attributes could affect the client care for this hypothetical client . Include how these attributes could affect the client’s recovery and what they would do to help this person . Students will present this information to the class and talk about what it would be like to try to help this person . As a class, the students will debrief the exercise and talk about the implications for practice . Students will critically examine various clients’ situations and how a constellation of factors can affect a person’s ability to recover . Social workers must be able to identify their preconceived notions about privilege and disabilities . Students will learn how to create a treatment plan with a variety of clients, drawing on the available resources within the person’s network and in their city or state . Students will be asked to explore their own perceptions about specific attributes and reflect how these perceptions change or are influenced by one’s own biases . 34 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

Assignments Resource Competency Dimension

Students will identify the neighborhoods in their city that have a low Knowledge proportion of treatment centers per resident . They will write a report that Values presents empirical data showing the correlation of treatment options and incarcerations for drug-related offenses . Students will advocate for social Skills justice by writing their state representatives to present their findings . Students will be able to articulate the data that explore the relationship between density of treatment centers and rates of incarceration . Social workers value a society that addresses public health needs . Students will write letters to their representatives stating their arguments .

Compare popular media’s portrayal of drug use among Latinx with Knowledge evidence from the scholarly literature . Pay careful attention to the following article: Salas-Wright, C . P ., Vaughn, M . C ., & Goings, T . C . (2017) . Immigrants from Mexico experience serious behavioral and psychiatric problems at far lower rates than US-born Americans . Social Psychiatry & Psychiatric Epidemiology, 52, 1325–1328 . Students will discuss differences in scholarly information regarding drug use among Latinx and compare the findings to state and federal policies that are targeted to Latinx .

Students will work in groups of four or five people for this assignment . Knowledge Each group will be assigned a specific type of substance (e g. ., nicotine or Values vaping, alcohol, marijuana, methamphetamines, opioids) for which they will research the following: Skills ● Their group’s initial understanding and perceptions of the substance Cognitive and Affective ● The psychotropic effects of the substance and the biological, Processes psychological, social, economic, and environmental consequences of using the substance ● Five examples of how public messaging through media, social media, or community discussion boards (e g. ,. Reddit) portray this substance Students will prepare a 20-minute presentation that discusses (1) their initial perceptions, (2) how these perceptions changed with empirical evidence for psychotropic effects and associated consequences, (3) their selection of public messaging examples, and (4) an analysis of how public messaging aligns or misaligns with evidence and how it might influence perceptions of the substance . Students will identify the actual effects and consequences of a specific substance in addition to public discourse associated with use of this substance . Students will evaluate how public messaging conveys values that may or may not align with empirical evidence . Students will use critical thinking skills to compare the relative influences of evidence and public messaging . Students will be asked to explore their own perceptions or biases about a specific substance and reflect how their perceptions change or are influenced by empirical evidence . Competency 3: Advance Human Rights and Social, Economic, and Environmental Justice 35

Media Resource Competency Dimension

TEDMED Talk, “Let’s Quit Abusing Drug Users ”. . Knowledge https://www youtube. .com/watch?v=C9HMifCoSko Values Skills Cognitive and Affective Processes

Gounder, C . (2018) . In Sickness and in Health podcast: season 2, episode 11, Knowledge “Race and the War on Drugs ”. Values

Gounder, C . (2018) . In Sickness and in Health podcast, season 2, episode 6, Knowledge “Cops as Social Workers?” Values

Video: Open Society Foundation, Human Rights, and International Drug Knowledge Control . Values https://www .opensocietyfoundations .org/voices/parallel-universes -human-rights-and-international-drug-control

Field Activities Resource Competency Dimension

Students will advocate for social justice at the macro system level by Knowledge traveling to their state house to meet with their district representatives . Values Students will advocate for legislation that appropriates funding for treatment agencies in neighborhoods that are underserved in order to decrease drug abuse among marginalized groups . Research shows that treatment centers are less available in high–drug use areas than in privileged areas with low levels of drug use . Students will address how increasing equitable access to drug treatment must be based on demand .

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Field Activities (continued)

Resource Competency Dimension

Students will engage in a field activity that advances environmental Knowledge justice . Students will form groups to discuss strategies identified by Values activists they see as effective in reducing alcohol-related problems . Groups will choose one activity identified by the authors and apply it in the community . [Drabble, L ,. & Herd, D . (2014) . Strategies employed by inner-city activists to reduce alcohol-related problems and advance social justice . Journal of Ethnicity in Substance Abuse, 13, 362–384] . Students will learn at least three strategies that activists use to address drug use and dependency in the community . Students will address the importance of intervening at the macro level to advocate for individuals, families, and groups that are affected by drug use in the community .

Students will write a paper to be addressed to the Appropriation Knowledge Committee of Congress that will support the fundamental human right Skills to behavioral health care . Students will advocate for community-based treatment centers rather than treatment at inpatient settings . They will present evidence that African Americans who are less likely to be able to afford inpatient drug treatment may be more successful if the treatment is community based . White, W . L ., & Sanders, M . (2008) . Recovery management and people of color: Redesigning addiction treatment for historically disempowered communities . Alcoholism Treatment Quarterly, 26, 365–395 . Students will explain the importance of nonacute care for drug dependence among different ethnic groups and advocate for marginalized people who use or are dependent on drugs .

Students will attend two AA or two NA meetings . The two meetings Knowledge should be in socioeconomically different geographic areas . The students Values then write a self-reflective report comparing what they expected to see at the meetings with what they experienced . See Appendix 3B for Cognitive instructions . and Affective Processes Students will learn how 12-step meetings are structured and that people from all walks of life attend them . Students will identify personal biases they had about people who use drugs or are alcohol or drug dependent . Social workers must develop empathy for people who use or are dependent on drugs . One way to develop empathy is to listen to their stories and try to identify with them . Competency 3: Advance Human Rights and Social, Economic, and Environmental Justice 37

APPENDIX 3A: LEARNING ACTIVITIES ON CHANGING MARIJUANA POLICIES AND ATTITUDES Currently, most states in the United States have decriminalized marijuana use to some extent. This major shift in drug laws raises the question, “When the laws change, how do we respond to people who currently hold criminal records, are under probation, or are in jail or prison for marijuana-related crimes?” To put this question into context, marijuana crimes typically account for about 30% of drug arrests, which means a large proportion of Americans have been affected by activities that are now no longer viewed in the same way (e.g., the same activity that once was a felony is now a misdemeanor). In small groups, discuss the following:

1) What are the consequences of having a criminal record?

2) Although marijuana is used at similar rates across racial and ethnic groups, criminal arrests for marijuana-related crimes occur predominantly among Black, Hispanic, and Native American populations. How does this differentially affect communities of color?

3) Should we expunge past marijuana convictions to reflect the current laws?

a. How does removing past convictions potentially change the lives of people with past criminal records or those who are on probation or currently in jail or prison for marijuana-related crimes?

b. What are the potential unintended consequences of removing past marijuana convictions for communities and society?

APPENDIX 3B: FIELD ASSIGNMENT ON DETECTING BIASES ABOUT PEOPLE WHO USE DRUGS OR ARE ALCOHOL OR DRUG DEPENDENT Most people have preconceived notions about the kind of person who attends AA or NA. Attending meetings is a good way to examine one’s biases about people in recovery. Students will attend two AA or two NA meetings. The two 38 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE meetings should be in socioeconomically different geographic areas. The students then to write a self-reflective report comparing what they expected to see at the meetings with what they experienced. The objectives of the paper:

1) Compare what you expected the people at the meetings to be like with what you experienced.

2) Explain how meetings in the less affluent neighborhood were similar to or different from meetings in a more affluent neighborhood.

3) What about their stories or comments surprised you?

For the actual experience, follow these directions:

1) Meetings are idiosyncratic and differ from group to group. Go to at least two of the same type of meetings in different neighborhoods so you will get a wider sense of 12-step meetings than you would get with just one meeting. Don’t mix and match; attend either two AA or two NA meetings, not one AA and one NA, and not in the same neighborhood.

2) The codes for the types of meeting are accessible on their websites. For example, an open discussion meeting is coded “OD.” Go only to open (“O”) meetings, not closed (“C”) meetings. Open meetings are designed for people who are family members, friends, therapists, and other interested parties.

3) Closed meetings are closed to everyone who doesn’t want to stop drinking or using drugs. Those meetings begin with “C.” For example, a closed discussion meeting is listed as “CD.”

4) Go to speaker or discussion meetings so you can listen to people talk about their experiences. It won’t be that helpful to go to literature meetings (e.g., Big Book [“BB”], Step Study [“SS”], or As Bob Sees It [ABSI]), because most of the meeting will be devoted to reading. Don’t go to a meditation (“M”) meeting, because no one will be speaking. Competency 4 Engage in Practice-informed Research and Research-informed Practice

COMPETENCY DESCRIPTION Social workers working with individuals and communities affected by substance use learn and develop skills to evaluate research and think critically about substance use and SUDs. Social workers use theoretical frameworks, psychometric instruments, and diverse approaches to contextualize the practice and research relationship. Social workers integrate experience with theory to use practice-based evidence to monitor treatment effectiveness, inform scientific inquiry, and enrich research on substance use. Social workers recognize the systemic disconnect between substance use services and the larger healthcare system—and how this contributes to the gap between research and practice. Social workers use interdisciplinary research that integrates biological, psychological, social, cultural, historical, and other contextual factors relevant to substance use research, practice, and policy. Social workers respect human dignity and are particularly mindful of the impact of stigma, discrimination, and marginalization on substance use research and practice.

COMPETENCY BEHAVIORS

● Recognize the role of participants in research on substance use. Use research in practice that reflects the dignity and autonomy of participants in substance use research and abides by the principles of ethical research. Recognize personal biases when engaging in research-informed practice and practice-informed research.

39 40 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

● Use substance use–relevant theory, research literature, and practice experience to inform scientific inquiry and practice evaluation and continually critique and evaluate the effectiveness of theoretical frameworks, psychometric instruments, and approaches that explain or predict, assess, and treat SUDs.

● Apply the hierarchy of evidence to compile, synthesize, and apply substance use research to inform treatment approaches through effective dissemination and implementation strategies.

● Use research to contextualize evidence-based practice and policy approaches, depending on the substance use setting, developmental stage or phase, and cultural background, seeking input from the populations directly affected by substance use to inform research and guide its derivatives.

CURRICULAR RESOURCES MAPPED TO COMPETENCY DIMENSIONS

Readings Resource Competency Dimension

Begun, A . L ., & Gregoire, T . (2014) . Conducting substance use research . Knowledge Oxford University Press .

Castonguay, L . G ., Eubanks, C . F ., Goldfried, M . R ,. Muran, J . C ., & Lutz, W . Knowledge (2015) . Research on psychotherapy integration: Building on the past, Cognitive looking to the future . Psychotherapy Research, 25(3), 365–382 . and Affective Processes

Damschroder, L . J ., & Hagedorn, H . J . (2011) . A guiding framework and Knowledge approach for implementation research in substance use disorders Cognitive treatment . Psychology of Addictive Behaviors, 25(2), 194–205 . and Affective Processes

Goodman, J . D ., McKay, J . R ., & DePhilippis, D . (2013) . Progress monitoring Knowledge in mental health and addiction treatment: A means of improving care . Professional Psychology: Research and Practice, 44(4), 231–246 .

(continued) Competency 4: Engage in Practice-informed Research and Research-informed Practice 41

Readings (continued)

Resource Competency Dimension

Knudsen, H . K ., & Roman, P . M . (2014) . Innovation attributes and adoption Knowledge decisions: Perspectives from leaders of a national sample of addiction Values treatment organizations . Journal of Substance Abuse Treatment, 49, 1–7 .

McGovern, M . P ., & Carroll, K . M . (2003) . Evidence-based practices for Knowledge substance use disorders . Psychiatric Clinics of North America, 26, Values 991–1010 .

Mee-Lee, D ., McLellan, T . A ,. & Miller, S . D . (2010) . What works in substance Knowledge abuse and dependence treatment . In B . L . Duncan, S . D . Miller, B . Cognitive E . Wampold, & M . A . Hubble (Eds .), The heart and soul of change: and Affective Delivering what works in therapy (2nd ed ., pp . 393–417) . American Processes Psychological Association .

Miclette, M . A ., Leff, J . A ,. Cuan, I ,. Samet, J . H ., Saloner, B ., Mendell, G ., . . Knowledge . Meisel, Z . F . (2018) . Closing the gaps in opioid use disorder research, Values policy and practice: Conference proceedings . Addiction Science & Clinical Practice, 13(22), 1–6 .

Miller, W . R ., Sorensen, J . L ., Selzer, J . A ,. & Brigham, G . S . (2006) . Knowledge Disseminating evidence-based practices in substance abuse treatment: Values A review with suggestions . Journal of Substance Abuse Treatment, 31, 25–39 .

The National Center on Addiction and Substance Use at Columbia Knowledge University . (2012) . Addiction medicine: Closing the gap between science Values and practice . Author . Cognitive and Affective Processes

National Commission for the Protection of Human Subjects of Biomedical Knowledge and Behavioral Research . (1978) . The Belmont report: Ethical principles Values and guidelines for the protection of human subjects of research . U .S . National Commission for the Protection of Human Subjects of Cognitive Biomedical and Behavioral Research . and Affective Processes

O’Hare, T . (2015) . Evidence-based practices for social workers: An Knowledge interdisciplinary approach (2nd ed ). . Lyceum Books . Cognitive and Affective Processes

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Readings (continued)

Resource Competency Dimension

Seitz, J ., & Mee-Lee, D . (2017) . Feedback-informed treatment in an Knowledge addiction treatment agency . In D . S . Prescott, C . L . Maeschalck, & S . D . Miller (Eds .), Feedback-informed treatment in clinical practice: Reaching for excellence (pp . 231–248) . American Psychological Association .

Tabak, R . G ., Khoong, E . C ., Chambers, D ., & Brownson, R . C . (2012) . Knowledge Bridging research and practice: Models for dissemination and implementation research . American Journal of Prevention Medicine, 43, 337–350 .

Wells, E . A ., Kristman-Valente, A . N ., Peavy, K . M ., & Jackson, T . R . (2013) . Knowledge Social workers and delivery of evidence-based psychosocial treatments for substance use disorders . Social Work in Public Health, 28(3–4), 279–301 .

Learning Activities Resource Competency Dimension

Theory-informed research and practice for substance use. Knowledge See Appendix 4A . Cognitive and Affective Processes

Formulate a research question for substance use research. Knowledge See Appendix 4B . Values

Field Activities Resource Competency Dimension

Evidence-based Practice for Substance Use Knowledge This activity aims to help students define evidence-based practice Cognitive (EBP) and differentiate EBP from similar practices, to identify the and Affective steps involved in decision-making processes grounded in EBP . The Processes student refers to a practice situation and applies the six steps of the EBP decision-making process as outlined by Drisko (2014); the student develops a research paper, which may be used for practice in field education .

(continued) Competency 4: Engage in Practice-informed Research and Research-informed Practice 43

Field Activities (continued)

Resource Competency Dimension

Instructions: Refer to the following article: Drisko, J . (2014) . Research evidence and social work practice: The place of evidence-based practice . Clinical Social Work Journal, 42, 123–133 . Identify a client from your field placement who deals with substance use–related problems and use the model in the article to identify an EBP approach to the client’s presenting problem . There are six steps in the EBP decision-making process, as described by Drisko (2014, p . 125): 1 . Drawing on client needs and circumstances learned in a thorough assessment, identify answerable practice questions and related research information needs . 2 . Efficiently locate relevant research knowledge . 3 . Critically appraise the quality and applicability of this knowledge to the client’s needs and situation . 4 . Discuss the research results with the client to determine how likely effective options fit with the client’s values and goals . 5 . Synthesizing the client’s clinical needs and circumstances with the relevant research, develop a shared plan of intervention collaboratively with the client . 6 . Implement the intervention . Write the Paper: (a) Set the stage by describing the presenting problem and any other information that you will include as a search term . (b) Describe the search terms and literature sources for your research-informed approach (see Drisko, 2014, p . 126) . (c) Discuss what you found in the search . (d) Critique each of the articles for its appropriateness for this client’s circumstances and preferences . (e) What approach did you select and why? (f) How would you use these methods with your client? Use a pseudonym to refer to your client and avoid revealing personally identifiable information .

Assignments Resource Competency Dimension

Practice-informed Research Project Knowledge As a project involving higher-order thinking skills (e g. ,. evaluation and Values development), this project can be used as a midterm, final, or capstone Cognitive project for your students . The project is designed as a group assignment, and Affective although it may work well as an individual assignment . You may decide to Processes break the assignment down into deliverables throughout the semester, to foster and monitor students’ work .

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Assignments (continued)

Resource Competency Dimension

Step 1: Configure student groups based on work at similar agencies or with similar populations . Identify a practice challenge as it relates to a specific population . Some examples of practice challenges pertinent to substance use include screening, assessment, client engagement and retention, intervention, relapse, readmission, and ineffective or nonexistent agency policies or procedures . Ask students to provide a report in which they do the following: ● Present a detailed analysis of the population, problem, setting, and practice challenge . Say, for example, that a group is formed with students placed at behavioral health facilities providing services to adult clients with substance use–related issues . In this example, the practice challenge involves increasing client engagement, because very few clients present for treatment for SUDs after completing screening . ● Although the characteristics of the adult clientele at various facilities vary, students may describe demographic characteristics of the clientele and aspects relevant to substance use, such as mean age at substance use initiation, drug use types, patterns, and trajectories, and mean number of treatment episodes . What are the characteristics of the community in which clients live? Is this a predominantly urban or rural area? ● Indicate the desired outcome . Students need to discuss outcome measures and how they will go about collecting data and measuring the desired outcome . Step 2: Gather information on problem resolution to achieve desired outcome . Review information and options and reach a consensus on which options to select for implementation . Possible steps include the following: ● Consultation with key stakeholders, clients, staff, or experts in the field . Students discuss baseline characteristics of the problem, focusing on variables that may explain the problem . Students may be encouraged to differentiate between person-level variables related to the problem (e g. ,. clients’ disagreement with diagnosis or treatment plan) and contextual variables (e g. ,. accessibility and transportation to the clinic) . Students discuss problem framing, that is, how and by whom the problem is being defined (e g. ,. how well clients accept a diagnosis of substance use disorder) . Students may find it helpful to use the “stages of change” model in defining the problem and building empathy toward clients . The preceding analysis serves as the basis for a course of action aiming to alleviate the problem at stake . ● Reviews of best practice literature and research . Students need to consult peer-reviewed literature that supports their choice of course of action . You may encourage students to refer to the hierarchy of evidence (e g. ,. prioritizing study designs such as randomized controlled trials, observational studies using propensity-score matching) while consulting systematic reviews and meta-analyses .

(continued) Competency 4: Engage in Practice-informed Research and Research-informed Practice 45

Assignments (continued)

Resource Competency Dimension

Step 3: Create a logic model to guide selection of new or altered intervention . ● Problem-solve implementation challenges and propose strategies . Ask the student to compare the approach (if any) currently being implemented at the agency to (e g. ,. to deal with client engagement) and the theoretical approached proposed in the logic model . You may refer to the University of Kansas Community Toolbox (2018) for information on how to develop a logic model . Step 4: Select and design an evaluation strategy to measure achievement of the desired outcome . ● Discuss anticipated outcomes and anticipated successes and challenges associated with project implementation . Try to capitalize on using or modifying existing agency data sources . Consider both quantitative and qualitative data collection and analysis methods, including client self-report data . Ask the students to discuss issues with confidentiality of client records (how client data will be stored and who will access the data) and special considerations relevant to substance use as they propose to measure progress toward problem resolution . Create comparison groups (e g. ,. business as usual, retrospective data), as feasible . Present a report with the findings and specify how each student in the team contributed to the work behind the report .

Evaluating Evidence-based Practice for Unique Populations Knowledge The aim of this assignment is to help the students analyze and synthesize Skills literature on treatment models for SUDs, focused on a population of interest . Instructions: Each student selects a population affected by substance use–related problems and locates five peer-reviewed studies that evaluate a treatment model effective for the problem and selected population . For example, a student analyzes five studies that show that cognitive– behavioral therapy appears to work well for adolescents with cannabis use disorder . Provide the following instructions to the student: 1 . Describe the population you are exploring . This section should include general demographics and a description of why this population is considered to benefit from the unique approach . 2 . Name and provide the citation for the article . 3 . Provide a brief description of the study . 4 . Describe the sample and methods for the study . 5 . Describe the treatment model being evaluated . 6 . Mention the study limitations, as described by the researchers . 7 . Paraphrase the conclusions of the study . 8 . Provide your conclusions about the usefulness of the treatment model for the population (this requires a thorough review of all articles) . Do not use quotes in this paper . Refer to peer-reviewed scientific literature and, except for citing statistics, do not refer to websites . 46 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

Guides and Toolkits Resource Competency Dimension

Michigan Department of Community Health Bureau of Substance Abuse Knowledge and Addiction Services Evidence-based Workgroup Values ● Guidance document: Selecting, planning, and implementing Cognitive evidence-based interventions for the prevention of substance use and Affective disorders . https://www .michigan .gov/documents/mdch/Mich_ Processes Guidance_Evidence-Based_Prvn_SUD_376550_7 .pdf National Institute on Drug Abuse ● Harnessing the power of science to inform substance abuse and addiction policy and practice . https://archives .drugabuse . gov/testimonies/2014/harnessing-power-science-to-inform- substance-abuse-addiction-policy-practice ● Preventing drug use among children and adolescents: A research- based guide for parents, educators, and community leaders (2nd ed .) . https://www .drugabuse .gov/sites/default/files/ preventingdruguse_2 .pdf ● Principles of drug addiction treatment: A research-based guide (3rd ed .) . https://www .drugabuse .gov/publications/principles- drug-addiction-treatment-research-based-guide-third-edition/ evidence-based-approaches-to-drug-addiction-treatment Substance Abuse and Mental Health Services Administration ● Evidence-Based Practices Resource Center: https://www .samhsa . gov/ebp-resource-center ● Prevention Resources: https://www .samhsa .gov/prevention-week/ toolkit/prevention-resources ● Medications for Opioid Use Disorder: https://store .samhsa .gov/ system/files/sma18-5063fulldoc_0 .pdf ● Tennessee Department of Mental Health & Substance Use Services ● Substance use best practice tool guide . https://www .tn .gov/ behavioral-health/substance-abuse-services/treatment--- recovery/treatment---recovery/substance-use-best-practice-tool- guide .html

University of the Washington Alcohol, Drug Abuse Institute, and the Northwest Frontier Addiction Technology Transfer Center ● Evidence-based practices for substance use disorders . http://adai . uw .edu/ebp/x National Association of Social Workers ● NASW standards for social work practice with clients with substance use disorders . https://www .socialworkers .org/Practice/Practice- Standards-Guidelines Competency 4: Engage in Practice-informed Research and Research-informed Practice 47

APPENDIX 4A: THEORY-INFORMED RESEARCH AND PRACTICE FOR SUBSTANCE USE This activity has three major goals: to identify four person-in-the-environment theories of substance use disorders; to examine these theories while apprais- ing their utility in identifying modifiable factors that deter people from developing substance use–related problems or help manage these problems once initiated; and to foster recognition of the role of theory in social work research and practice for people with substance use–related problems. A week before the session, ask your students to read and analyze the following two articles:

Tsang, N. (1998). Beyond theory and practice integration in social work: Lessons from the west. International Social Work, 41(2), 169–180.

Moos, R. H. (2007). Theory-based processes that promote the remis- sion of substance use disorders. Clinical Psychology Review, 27(5), 537–551.

Begin the activity by asserting that integrating theory and practice in social work can be challenging (perhaps you might bring up examples from your own clinical practice that attest to the challenge). Mention that theories can be very useful in social work practice for people with SUDs. Refer to the article by Tsang (1998) and ask students to ponder the following quotes:

Social work theories

● “provide a useful tool for understanding, and as such provide a frame of reference to gain insight and expand alternatives for the practitioner who is often ‘stuck’ and ‘locked’ in practice situations with no easy answer for problem framing and solving” (p. 173)

● “inform the social workers about the nature of problems, and propose certain justifiable courses of action” (p. 173)

● “serve as a guide for analysis and action, a model for practice, a tool for understanding human behavior and feelings” (p. 172)

Ask students to brainstorm and write on the board examples, whether from field education, volunteer, or prior work experience, that relate to any of the 48 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE quotes. If few or no examples are provided, instruct students to come up with hypothetical situations which may embody the meaning behind any of the quotes. Finally, provide an example of your clinical experience relating to any of the quotes. Transition to a conversation focused on theory and practice for substance use. Mention that many social workers try to help their clients identify and promote factors with the potential to protect them from developing substance use–related problems or help them alleviate such problems once initiated and that theories of human behavior may help with the task at hand. Bring up the four theories mentioned in the article by Moos (2007): social control theory, behavioral economics/behavioral choice theory, social learning theory, and stress and coping theory. Divide the students into four groups and assign one of the theories to each group. Ask the students in each group to refer again to the article (Moos, 2007) and study only their assigned theory. Tell the students that, in a table drawn on the board, they will be asked to summarize the information about their theory and that they will prepare and present a report including the theory name, theory definition, theory processes or concepts, and modifiable factors and variables per the theory. To guide your students, you might decide to present the following example, applicable to social learning theory:

Theory Theory Theory Processes or Concepts Modifiable Factors Name Definition and Variables

Social (Here, students (a) “People who serve as role (a) “Romantic learning paraphrase the models set forth patterns partners are likely theory definition of the of substance use that may to influence each theory .) be observed and imitated other’s patterns by the individual ”. of substance use ”.

Ask the students from each group take turns filling in the table on the board with the information pertinent to their theory, presenting it to the group. Students may refer to findings from research studies quoted in the article (Moos, 2007) to provide examples of modifiable factors and variables. As students present their work, emphasize the connection between the processes or concepts of the theory and the modifiable factors and variables that the theory points out. Make sure the students in each group cover all major processes or concepts of their assigned theory. Competency 4: Engage in Practice-informed Research and Research-informed Practice 49

Once the first group has presented their work, continue with the presentations from the three remaining groups. When all groups have finished, have the students return to their seats. Ask all students in the class to consider their role as future social work professionals and write down responses to the following questions. Facilitate a conversation with their responses:

● How could you identify, during assessment or clinical intervention, the modifiable factors or variables that, as outlined by the theory in question, affect your client’s patterns of substance use?

● To what extent does diagnosis or the delivery of treatment for SUDs incorporate these processes or principles?

● Which pattern of experiences (if any) observed during field education seems to contradict the processes or principles outlined by the theory?

● What might be your role as a social work professional in closing the gap between theory and practice?

APPENDIX 4B: FORMULATE A RESEARCH QUESTION FOR SUBSTANCE USE RESEARCH The purpose of this guide is to help the students formulate a research question, which may be necessary for courses such as research methods; the guide may also provide some basis for professional work to research and better understand the substance use–related problems affecting a population.

1) Start by defining research. The term “research” has been defined as the process of “gathering the information you need to answer a question and thereby help you solve a problem” (Booth, Colomb, & Williams, 2003).

2) Think about one of your clients who deals with an SUD and presents for a substance use assessment as referred by Child Protective Services, Adult Probation, or any other agency. Answer the following questions, providing as much detail as possible:

● What is the problem—as defined by your client, the referring agency, any other stakeholder, and also by you?

● Who is affected by the problem? 50 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

● When and where is the problem happening?

● What are some reasons that may explain, sustain, or aggravate the problem?

3) Use the preceding answers to help you narrow down your research interests. Next, begin to formulate a research question; you might also decide to consider the type of research (exploratory, explanatory, descriptive qualitative or quantitative) that you want to conduct, based on considerations such as available skills and resources. Refer to the PICOT acronym (P, population; I, independent variables; C, control group; O, outcome or dependent variable; T, time period) to tease out the factors involved in the substance use–related problem; note that not every word in the acronym applies to all research designs.

4) Examples of research questions involving a common substance use– related problem for a given type of research study are shown next. Say, for example, that we are concerned about the behavior of Hispanic children who witness methamphetamine use by their parents. We would like to better understand whether these children are at risk for initiating alcohol or drug use during adolescence. Compare the research questions and study types; afterward, as applicable, select the study most appealing to you and replace the text regarding the independent (I) and outcome (O) variables, population (P), time period (T) (and control group [C], as applicable).

● Exploratory study (research that aims to gain familiarity with a topic):

Is exposure to methamphetamine use by a parent [I] associated with alcohol or drug use initiation [O] in adolescence [T] among Hispanic children [P]?

● Explanatory study (research that aims to test a hypothesis):

Are Hispanic children [P] exposed to methamphetamine use by a parent [I], compared with children who are not exposed to methamphetamine use by a parent [C], at increased risk for initiating alcohol or drug use[O] in adolescence [T]? Competency 4: Engage in Practice-informed Research and Research-informed Practice 51

● Quantitative descriptive study (research that aims to describe a phenomenon using numbers, primarily):

What are the demographic characteristics of Hispanic children [P] with a history of exposure to methamphetamine use by a parent [I] who initiate alcohol or drug use [O] in adolescence [T]?

● Qualitative descriptive study (research that aims to describe a phenomenon using data such as text, narratives, or photos):

How (in what ways) do Hispanic children [P] with a history of exposure to methamphetamine use by a parent [I] initiate alcohol or drug use [O] in adolescence [T]?

REFERENCES

Booth, W. C., Colomb, G. G., & Williams, J. M. (2003). The craft of research (2nd ed.). The University of Chicago Press. University of Kansas. (2018). Section 1. Developing a logic model or theory of change. https://ctb.ku.edu/en/table-of-contents/overview/models-for-community -health-and-development/logic-model-development/main

Competency 5 Engage in Policy Practice

COMPETENCY DESCRIPTION Social workers working with substance use are knowledgeable about evolv- ing policies that govern programs and services at the local, state, and federal levels that affect prevention, treatment, and recovery from SUDs. Those policies include services available to people across the lifespan, their families, and the wider community. Social workers recognize that oppressive and dis- criminatory policies have negatively affected vulnerable, disadvantaged, and underrepresented communities. Social workers actively engage in advocacy for more equitable, just, and current evidence-informed policies through formulation, analysis, implementation, and evaluation. Social workers support policies that affirm the dignity and worth of the individual, self-determination, and social justice of those affected by substance use.

COMPETENCY BEHAVIORS

● Maintain awareness of laws and policies at the organizational, local, state, federal, and global level related to prevention, treatment, and recovery.

● Analyze and evaluate policies affecting prevention, treatment, and recovery services with communities, organizations, families, and individuals.

● Advocate for changes in and creation of alcohol and other drug policies that improve the health and well-being of individuals, families, and communities that are at risk for or experiencing problems in living related to substance use.

53 54 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

● Engage people with lived experience in the process of policy development, implementation, and evaluation.

● Promote policies that improve prevention efforts, increase treatment capacity, build recovery capital, and support multiple pathways to recovery across systems.

● Advance policies that support the foundation of evidence to inform social work for people with SUDs.

CURRICULAR RESOURCES MAPPED TO COMPETENCY DIMENSIONS

Readings Resource Competency Dimension JOURNAL ARTICLES

Babor, T . F ., Del Boca, F ., & Bray, J . W . (2017) . Screening, Brief Intervention Knowledge and Referral to Treatment: implications of SAMHSA’s SBIRT initiative for substance abuse policy and practice . Addiction, 112, 110–117 .

Barry, C . L ., McGinty, E . E ., Pescosolido, B ., & Goldman, H . H . (2014) . Knowledge Stigma, discrimination, treatment effectiveness and policy support: Values Comparing public views about drug addiction with mental illness . Psychiatric Services, 65(10), 1269–1272 . Cognitive and Affective Processes

Griffith, C ., & France, B . L . (2018) . How does U .S . governmental policy Knowledge impact opioid treatment? International Journal of Applied Science: Research and Review, 5(3), 12 .

Imtiaz, S ., Probst, C ., & Rehm, J . (2018) . Substance use and population Knowledge life expectancy in the USA: Interactions with health inequalities and implications for policy . Drug & Alcohol Review, 37, S263–S267 .

Jones, M . R ., Viswanath, O ., Peck, J ., Kaye, A . D ., Gill, J . S ., & Simopoulos, T . Knowledge T . (2018) . A brief history of the opioid epidemic and strategies for pain medicine . Pain and Therapy, 7(1), 13–21 . https://doi org/10. 1007/s40122-. 018-0097-6

(continued) Competency 5: Engage in Policy Practice 55

Readings (continued)

Resource Competency Dimension

Kelly, J . F ., Bergman, B ., Hoeppner, B . B ., Vilsaint, C ., & White, W . L . (2017) . Knowledge Prevalence and pathways of recovery from drug and alcohol problems Values in the United States population: Implications for practice, research, and policy . Drug and Alcohol Dependence, 181, 162–169 .

Mechcatie, E . (2018) . The impact of legalization of medical and Knowledge recreational marijuana . American Journal of Nursing, 118(7), 16 .

Meisel, Z . F ., Mitchell, J ., Polsky, D ., Boualam, N ., McGeoch, E ., Weiner, Knowledge J ., . . . Cannuscio, C . C . (2019) . Strengthening partnerships between substance use researchers and policy makers to take advantage of a window of opportunity . Substance Abuse Treatment, Prevention & Policy, 14(1) .

Rehm, J ., Anderson, P ., Fischer, B ., Gual, A ,. & Room, R . (2016) . Policy Knowledge implications of marked reversals of population life expectancy caused by substance use . BMC Medicine, 14, 1–4 .

Scholten, W . (2018) . Global commission on drug policies Knowledge misses the mark . Drug Science, Policy and Law . https://doi . org/10 .1177/2050324518812110

Stuart, E . A ., Barry, C . L ., Donohue, J . M ., Greenfield, S . F ., Duckworth, K ., Knowledge Song, Z ., . . . Huskamp, H . A . (2017) . Effects of accountable care and payment reform on substance use disorder treatment: Evidence from the initial 3 years of the alternative quality contract . Addiction, 112(1), 124–133 .

Welsh, J . (2018) . Policy making in substance use treatment should be Knowledge evidence-based . American Journal on Addictions, 27(1), 52–53 . Values

WEB SOURCES

SAMHSA: Laws and Regulations Knowledge https://www .samhsa .gov/about-us/who-we-are/laws-regulations

NASW Social Justice Brief: A Social Work Perspective on Drug Policy Knowledge Reform Values https://www .drugpolicy .org/sites/default/files/Drug%20Policy%20 Reform%20Brief%20Social%20Justice%20Dept .pdf

NAADAC: Public Policy Department Knowledge https://www .naadac .org/public-policy

H .R .34: 21st Century Cures Act Knowledge https://www .congress .gov/bill/114th-congress/house-bill/34 Skills

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Readings (continued)

Resource Competency Dimension

S .524: Comprehensive Addiction and Recovery Act of 2016 Knowledge https://www .congress .gov/bill/114th-congress/senate-bill/524/ Skills

Key Sections of the Patient Portability and Affordable Care Act Knowledge https://www cms. gov/cciio/resources/regulations-and-guidance/index. html. Skills

Tribal Law and Order Act (TLOA) Knowledge https://www .congress .gov/111/bills/hr725/BILLS-111hr725enr .pdf Skills

Americans with Disabilities Act Knowledge https://www .ada gov/index. .html Skills

SAMHSA’s Website of Laws and Regulations related to Substance Use Knowledge Prevention and Treatment Skills https://www .samhsa .gov/about-us/who-we-are/laws-regulations

Learning Activities Resource Competency Dimension

Have the students view the video clip about discrimination against drug Knowledge users by the Drug Policy Alliance (http://www .drugpolicy .org/issues/ Values discrimination-against-drug-users) . Then, post or pass out the drug scheduling (https://www .dea .gov/drug-scheduling) . Cognitive and Affective Discuss how the policy of drug scheduling affects oppressed populations . Processes Discuss the difference in scheduling between cocaine and crack, pharmaceuticals, and heroin .

Drug Policy Debate Exercise (Total time approximately 1 hour) ● Choose a drug policy topic to be debated (e g. ,. legalization of marijuana, use of federal funds for needle exchange programs, or mandatory minimum sentencing) . ● Explain activity to students and form groups (liberal, conservative, audience) . Students are assigned by the instructor randomly to a group . Optional: Create a third “special interest group” depending on the topic to provide a critique of the issue from their perspective (e g. ., the neighborhood residents where needle exchange program would be offered, a racial or ethnic group disproportionately affected by the drug policy debated) . (3 minutes)

(continued) Competency 5: Engage in Policy Practice 57

Learning Activities (continued)

Resource Competency Dimension

● Students prepare for debate . Groups will create an argument for their position in a way that addresses the values, assumptions about human nature, responsibility of society and government, and race from the perspective of their assigned ideology . Liberals and conservatives prepare their opening remarks and points . The audience discusses what points they expect to see from each side of the debate . If a special interest group is formed, they discuss what concerns they see with the issue from the perspective of their population . Students may use course materials, cell phones, and laptops to research additional information if needed . (15 minutes) ● Students present their opening arguments . Order of presentation is determined by coin toss . Conservatives and liberals each have 4 minutes to present . If a special interest group is formed, they present third . The audience then may ask clarifying questions of liberals and conservatives . (10–14 minutes) ● Liberals and conservatives regroup to prepare rebuttals to the other side’s opening argument . If a special interest group is formed, they will use this time to devise a critique of both liberal and conservative presentations . The audience discusses and evaluates liberal and conservative opening presentations according to criteria provided (below) . (10 minutes) ● Each group (liberal and conservative) has 2 minutes to present rebuttals . Special interest group presents critique . (4–6 minutes) ● The audience asks clarifying questions of both liberal and conservative groups, then confers for scoring . (5 minutes) ● The audience provides feedback to liberal and conservative groups and declares a winner based on scoring criteria . (2 minutes) ● Whole class discussion (10 minutes) . Potential questions for discussion include “What was it like to argue an ideology or viewpoint that is not your own?” “Did the opposing group present points that you had not previously considered?” Audience scoring criteria: 1 . Clarity 2 . Adherence to ideology 3 . Thoroughness 58 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

Media Resource Competency Dimension

The House I Live In (2012) Knowledge http://www .thehouseilivein .org/ Values Cognitive and Affective Processes

Assignments Resource Competency Dimension

Students watch a clip from the HBO series Addiction (https://www . Knowledge youtube .com/watch?v=Hkh517a7MCM) and discuss the questions below . Values The assignment can be in class or as an online discussion forum . Skills Questions How do laws and policies that affect insurance coverage and reimbursement for the treatment of SUDs affect individuals, families, and agencies? Do you think we are in a better place now than when the video was recorded? If not, what do you think that says about policy and the need for advocacy? If it is substantially better, what do you think led to those improvements?

Interview the clinical director, CEO, or executive director of an agency Knowledge serving clients in the field of substance use . Skills Ask about the way that law and policy affect the agency, the agency practices, and the agency’s ability to provide services . Example Questions: How do laws and funding, both state and federal, effect the agency and its ability to provide services? What has that been like over time? How has it changed?

(continued) Competency 5: Engage in Policy Practice 59

Assignments (continued)

Resource Competency Dimension

Policy Analysis Knowledge Students will identify a current policy pertaining to substance use Skills prevention, treatment, or policing . Based on the chosen policy, students will conduct an analysis based on the framework taught in class . The paper must include the following elements: 1 . Introduction a . Introduce your paper and the paper content . 2 . Description of the policy a . What is your policy? b . How does this policy prevent, treat, or police substance use? c . Include important historical information leading up to the formation of the policy . d . Who were the stakeholders involved in the creation of this policy? 3 . Analysis a . Based on the framework chosen, complete the analysis . Note: This should be the bulk of the paper . Use outside sources to support your assertions and always explain why . 4 . Based on the previous information, synthesize, and develop a policy statement . 5 . Conclusion .

Competency 6 Engage With Individuals, Families, Groups, Organizations, and Communities

COMPETENCY DESCRIPTION Social workers working with substance use engage in collaborative working relationships with a wide array of client systems and stakeholders, potentially addressing substance use and related problems. The process of engagement establishes trusting, collaborative relationships and uses evidence-supported engagement and outreach practices. Skillful social work engagement occurs throughout the helping process. Social workers implement person-centered engagement practices appropriate to settings, circumstances, and populations that meet others’ readiness to engage and change. Social workers also engage with other professions or disciplines, paraprofessionals, peer support, community, and other natural and indigenous support systems at all levels of practice (micro, mezzo, and macro). Social workers continuously assess and adjust engagement processes over the course of the working relationship as clients’ and constituents’ needs, preferences, goals, and capabilities change over time. Social workers recognize how their own life experiences, training, and biases influence their engagement with diverse client systems and stakeholders.

COMPETENCY BEHAVIORS

● Demonstrate use of evidence-informed, -supported, or -based engagement practices appropriate to the situation, readiness to engage, and level of practice.

● Evaluate and adapt to how substance use, co-occurring problems, intersecting identities, and other diverse experiences influence engagement, disengagement, and reengagement processes.

61 62 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

● Engage members from families of origin, families of choice, created families, and other potentially supportive significant others, as appropriate, desired, and directed by clients and client systems.

● Participate at all levels of practice as a member of interprofessional and integrated teams (including other professions or disciplines, paraprofessionals, peer support, community and other natural and indigenous support systems), where all parts collaborate to identify and engage individuals and others in need of substance-related services and to establish and meet client system goals.

● Foster communication, establish and maintain rapport, and attend to the language that is used (i.e., nonstigmatizing, nonlabeling, person- centered) at all levels of practice and throughout the engagement process.

Readings Resource Competency Dimension

Campbell, C ., Smith, D ., Clary, K ., & Egizio, L . (in press) . Screening, Brief Knowledge Intervention, and Referral to Treatment (SBIRT) in the substance use system of care . In A L. . Begun & M . Murray (Eds .), Handbook of social work and addictive behavior. Routledge .

Center for Substance Abuse Treatment . (2006) . TIP 35/Treatment Knowledge Improvement Protocol series: enhancing motivation for change in Cognitive substance abuse treatment . DHHS Publication No . (SMA) 99-3354 . and Affective Substance Abuse and Mental Health Services Administration . http:// Processes www .ncbi .nlm .nih .gov/books/NBK14856/

Heather, N ., & Hönekopp, J . (2008) . A revised edition of the Readiness Skills to Change Questionnaire [Treatment version] . Addiction Research & Theory, 16(5), 421–433 . https://doi .org/10 .1080/16066350801900321 . https://www .researchgate .net/publication/232067129_A_revised_ edition_of_the_Readiness_to_Change_Questionnaire_Treatment_ Version

Nowinski, J ., Baker, S ., & Carroll, K . (1999) . Twelve step facilitation therapy Knowledge manual: A clinical research guide for therapists treating individuals with Skills alcohol abuse and dependence. National Institute on Alcohol Abuse and Alcoholism . Retrieved from https://pubs .niaaa .nih .gov/publications/ projectmatch/match01 .pdf

(continued) Competency 6: Engage With Individuals, Families, Groups, Organizations, and Communities 63

Readings (continued)

Resource Competency Dimension

Substance Abuse and Mental Health Services Administration . Recovery to Knowledge Practice . (2015) . Practicing recovery: Outreach and engagement. http:// Skills www .ahpnet .com/files/Newsletter_4_Sept_2015 .pdf Cognitive and Affective Processes

Wisdom, J . P ., Hoffman, K ., Rechberger, E ,. Seim, K ., & Owens, B . (2009) . Knowledge Women-focused treatment agencies and process improvement: Cognitive Strategies to increase client engagement . Women & Therapy, 32(1), and Affective 69–87 . https://doi org/:10. 1080/02703140802384693. . https://www . Processes ncbi .nlm .nih .gov/pmc/articles/PMC2748928/

REFERENCE

Connors, G . J ., Donovan, D . M ., Velasquez, M ,. & DiClemente, C . C . (2013) . Knowledge Substance abuse treatment and the stages of change: Selecting and Skills planning interventions . Guilford Press .

Greer, A . M ., Luchenski, S . A ., Amlani, A . A ., Lacroix, K ., Burmeister, C ., & Knowledge Buxton, J . A . (2016) . Peer engagement in harm reduction strategies Values and services: A critical case study and evaluation framework from British Columbia, Canada . BMC Public Health, 16(1), 452 . https://doi . org/10 .1186/s12889-016-3136-4

Mauro, P . M ., McCart, M . R ., Sheidow, A . J ., Naeger, S . E ., & Letourneau, E . Knowledge J . (2017) . Parent and youth engagement in court-mandated substance use disorder treatment . Journal of Child & Adolescent Substance Abuse, 26(4), 324–331, https://doi .org/10 .1080/1067828X .2017 .1305935 https://www .ncbi .nlm .nih .gov/pmc/articles/PMC5607020/

Rosengren, D . B . (2018) . Building motivational interviewing skills: A Knowledge practitioner workbook . Guilford Press . Cognitive and Affective Processes

Simmons, R ., Ungemack, J ., Sussman, J ., Anderson, R ,. Adorno, S ,. Aguayo, Knowledge J ., Black, K ., Hodge, S ,. & Timady, R . (2008) . Bringing adolescents into substance abuse treatment through community outreach and engagement: The Hartford Youth Project . Journal of Psychoactive Drugs, 40(1), 41–54 . https://doi .org/10 1080/02791072. .2008 10399760.

Subica, A . M ., & Douglas, J . A . (2019) . Engaging disadvantaged Knowledge communities in targeting tobacco-related health disparities and Values other health inequities . International Quarterly of Community Health Education . https://doi .org .10 .1177/0272684X19839866

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Readings (continued)

Resource Competency Dimension

Tracy, K ., Burton, M ., Nich, C ., & Rounsaville, B . (2011) . Utilizing peer Knowledge mentorship to engage high recidivism substance-abusing patients in Values treatment . American Journal of Drug and Alcohol Abuse, 37(6), 525–531 . https://doi .org .10 .3109/00952990 .2011 .600385

Treno, A . J ., Lee, J . P ., Freisthler, B ., Remer, L . G ., & Gruenewald, P . J . Knowledge (2005) . 4 4. Application of evidence-based approaches to community interventions . In T . Stockwell, P . J . Gruenewald, J . W . Toumbourou, & W . Loxley (Eds .), Preventing harmful substance use: The evidence base for policy and practice (pp . 177-189) . Wiley .

Learning Activities Resource Competency Dimension

Motivational Interviewing Practice Small Group Exercise Knowledge https://adept .missouri .edu/wp-content/uploads/2017/06/Module-Two- Values Motivational-Interviewing-Tools-and-Techniques .pdf Cognitive See Appendix 6A . and Affective Note: Students can work in small groups using the referenced guide . Processes

Exploring the Use of Harm Reduction Strategies for Engagement Into Knowledge Treatment Values See Appendix 6B . Cognitive and Affective Processes

Engagement Cinema Knowledge Students identify a video clip that demonstrates motivational interviewing Values (MI) skills in an engagement situation . This clip can be from a movie, Cognitive television show, YouTube, or other source . Alternatively, students may and Affective choose to write their own script and video record this interaction . Processes Clips should be no more than 5 minutes . Students submit a transcript of the recording identifying spoken lines on the left side and MI skills demonstrated on right side . If a student sees an opportunity for additional MI skills that could have been used, they can also be noted in right column . Student groups will introduce clips and briefly lead the class in a discussion of the MI skills they identified .

(continued) Competency 6: Engage With Individuals, Families, Groups, Organizations, and Communities 65

Learning Activities (continued)

Resource Competency Dimension

One Change I Would Like to Make Knowledge Adapted from Miller, W . R . (2019) . Listening well. Wipf and Stock Publishers . Skills After learning about the OARS skills (open questions, affirmation, reflective listening, and summarizing), students practice using reflective statements, working in pairs . One assumes the role of social worker and the other as the client . The client begins the conversation with “One Change I Would Like to Make Is [insert change],” and the social worker responds using only reflection . This continues for about 3 minutes with the social worker only using reflection, then roles switch . Variation: Using a deck of cards, students alternate between providing open-ended questions (hearts), affirmations (spades), simple reflections (diamonds), and complex reflections (clubs) . After designated time students provide a brief summary before switching roles .

Media Resource Competency Dimension

SAMHSA Recovery Support Tools & Resources related to Peer Workers: Knowledge https://www .samhsa .gov/brss-tacs/recovery-support-tools/peers Values

Engaging Youth for Community Change: Minnesota Department of Knowledge Health Example https://www .health .state .mn .us/communities/tobacco/initiatives/tfc/ stories/201807/index .html

Partnership for Drug Free Kids: Resource for Engaging Parents Knowledge https://drugfree .org/parent-blog/not-getting-anywhere-talking-to- your-child-about-their-drug-use-try-changing-your-tone-of-voice/

Assignments Resource Competency Dimension

Recovery Month Activity Knowledge (Activity is listed below for easy access by group .) Values See Appendix 6C . Cognitive The objective is for students to develop creative strategies for getting and Affective out the word about recovery, reducing stigma, and finding new ways to Processes engage individuals, groups, and communities affected by substance use . This activity can be modified for other times of year (outside of National Recovery Month) to emphasize engagement .

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Assignments (continued)

Resource Competency Dimension

Develop an Outreach Tool for Engaging Community Members Into Active Knowledge Change Skills See Appendix 6D . The objective is learning to develop tools for engaging a geographic- based or online community in active change on substance use issues in their communities .

Review of Evidence-based Approaches to SUD Intervention (Focus on Knowledge Engagement) Skills See Appendix 6E . Cognitive The objective is for students to develop knowledge in assessing the and Affective evidence about engagement practices in substance use; they compare Processes different approaches, consider the role of helping professionals in engagement, and are exposed to various skills in developing and managing the cognitive and affective aspects of helping relationships .

Group Paper and Presentations on Special Populations Knowledge See Appendix 6F . Skills The objectives include developing knowledge of SUDs and practice approaches for special populations and shaping their attitudes and skills for engaging and developing resources for special populations experiencing SUDs, particularly where co-occurring problems exist .

Past episodes can be viewed free online by going to the A&E website, www .aetv .com/intervention .

Field Activities Resource Competency Dimension

Twelve-step Meeting Observation and Reflection Knowledge See Appendix 6G . Values Students are encouraged to attend the meeting in pairs but complete Cognitive individual assignments . Ensure that students know the difference between and Affective open meetings and those intended only for individuals in recovery; Processes they should attend only open meetings for this activity, even if they are themselves in recovery!

(continued) Competency 6: Engage With Individuals, Families, Groups, Organizations, and Communities 67

Field Activities (continued)

Resource Competency Dimension

Stigma Busting: Engagement at a Community Level Knowledge This activity encourages students to work in small groups to identify a Values myth surrounding SUDs and to develop a plan to increase community Cognitive awareness and knowledge of the chosen area . After presenting ideas and Affective to the instructor and class and adjusting based on class and instructor Processes feedback, students will share materials at a designated community space or event .

Referral Resource Scavenger Hunt Knowledge Conduct a “scavenger hunt” for websites appropriate for individuals or Skills significant others (e g. ., family, friends, employers) concerning services and programs they might consider; create a referral index for yourself on these sites . (A similar activity might be to create a referral index for yourself for services and programs in the community or communities where you plan to work . For example, The National Institute on Drug Abuse, The National Institute on Alcohol Abuse and Alcoholism, SAMHSA, both state and county office/division of mental health and addiction services, and local United Way listings might be places to start .) An index should have access information but also annotation about what information can be gleaned from the source and to whom the resource might be recommended or not be recommended (and why) .

APPENDIX 6A: MOTIVATIONAL INTERVIEWING PRACTICE – SMALL GROUP EXERCISE Students will work in small groups using the MI guide. The goal of this assignment is to enhance student’s knowledge, skills, and abilities to engage clients around issues of substance use by practicing the various techniques from the guide. The supplemental practice guide is designed to allow students the opportunity to practice various techniques that may enhance client engagement around issues of SUD by:

● Exploring client readiness to change;

● Identifying client ambivalence around SUD, treatment and recovery;

● Exploring challenges to entering treatment, reducing use, or engaging in harm reduction strategies; 68 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

● Assessing pros and cons of treatment, recovery, and/or harm reduction; and

● Identifying roadblocks that may get in the way of addressing client SUD.

Students should take turns practicing the various MI techniques in the guide with their partner(s), and make notes regarding your reflections on how you and your partner(s) were able to put these techniques into practice and what struggles you encountered. At the conclusion of the small group activity, a larger class discussion will be conducted where groups will report back to the larger group various ways they found the activities effective in helping them engage with clients and ways they found the activities challenging. Groups will also have an opportunity to share examples from field or case studies where they might use an activity with a client and discuss why the activity would be helpful with their client and/or population.

APPENDIX 6B: EXPLORING THE USE OF HARM REDUCTION STRATEGIES FOR ENGAGEMENT INTO TREATMENT After an introductory lecture on harm reduction philosophy and methods, split the class into small groups of 4 to 5 students. Have students first identify and discuss their level of familiarity of and personal comfort with the use of harm reduction strategies. Then, ask the group to identify at least 3 potential benefits of using harm reduction strategies to engage clients into treatment (in lieu of abstinence-only models) and 3 potential challenges of using harm reduction strategies to engage clients into treatment (in lieu of abstinence-only models) based on their shared knowledge/experience. Each group will share their identified benefits and challenges on a white board or computer projection system to create a compiled list that will be shared with the whole class. Each group will have a representative share out parts of the discussion that they found compelling or interesting with the larger class. Instructor should facilitate larger group discussion around the results of small group interactions. Competency 6: Engage With Individuals, Families, Groups, Organizations, and Communities 69

APPENDIX 6C: RECOVERY MONTH ACTIVITY September is National Recovery Month, and the class will have an opportunity to let their creativity shine by creating a Recovery Month activity. Students may wish to review these resources to guide them on possible activities:

https://recoverymonth.gov/

http://www.treatmentsolutions.com/different-ways-to-celebrate -recovery-month/

The objective is for students to find creative ways to get the word out about Recovery, reduce the stigma in discussing and engaging with this topic, and find new ways to reach an engage individuals, groups, and communities affected by substance use. Marginalized and underserved groups are of particular concern, and recovery efforts should be inclusive of traditionally underserved populations. Students will present their activity ideas in class, and are not required to present to the general public. Students should consider:

● Creativity Professional presentation of information/activity/craft, etc.

● Use of audio/visual/technology/artistic activities

● Who is the target group of your message? How would this group/ population know this message is for them? Do you think a lay person would know?

● How has this activity impacted your ideas about substance abuse? Recovery? Ways to engage clients in different ways?

*Students are to submit any scholarly resources, links, texts, or other materials that assisted them in producing their activity to the instructor on the day of their presentation. *Students may also provide any materials to classmates if they are available. Students will work in small groups on this activity. Students will be allotted time on the first session to form groups and begin thinking about activities to pursue. A schedule of presentations will be determined after groups are formed. 70 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

APPENDIX 6D: DEVELOP AN OUTREACH TOOL FOR ENGAGING COMMUNITY MEMBERS INTO ACTIVE CHANGE Objective: Learn how to develop tools that can be used to engage a geographic-based, identity-based, or online-based community around active change in substance-related issues within their community.

Instructions: The instructor will identify a local community or organization that is interested in collaborating with the class to engage community members to work towards changing a community defined substance-related concern. Students will work in teams of approximately 4 people. Through a 15 minute presentation, each will share their outreach tool to the local community/organization as a potential resource that they can leverage in real time.

1) Students will create a brief community assessment that summarizes:

● Community-defined social concern related to substance manufacturing, distribution, and/or use in their community.

● Community demographics and other relevant characteristics/ structures.

● Associated community strengths, resources, and needs.

2) Students will work to identify the best way to engage community members and develop a product that is aimed at getting individuals interested in the local issue and potentially involved with local organizing efforts. Examples can include but are not limited to written materials (posters, pamphlets), audiovisual products (videos), online/social media platforms (website, social media campaign), or in person strategies (performances).

3) The presentation should clearly identify the identified substance-related concern, purpose of the outreach tool (I.e., building interest/awareness versus increasing involvement), target audience, an overview of the outreach tool itself, and how the community assessment helped to inform why this tool will likely be effective for the identified target audience. Competency 6: Engage With Individuals, Families, Groups, Organizations, and Communities 71

APPENDIX 6E: REVIEW OF EVIDENCE BASED APPROACHES TO SUBSTANCE USE DISORDER INTERVENTION-WITH A FOCUS ON ENGAGEMENT Choosing from a provided list of evidence-based registries or review of practice approaches as a starting point, compare and contrast 2 different approaches to treatment of addictive disorders. This analysis should include:

1) A summary of how the approach conceptualizes addiction (medical, legal, social, psychological) including response to relapse and moder- ation management;

2) A description of how this approach utilizes information based on clinical evaluation;

3) A comparison of how engagement might be approached within each of these clinical approaches;

4) Specific details about how the approach influences the engagement strategy from a clinical perspective;

5) A description of any evidence for utilization of these engagement strategies (hint: there should be evidence, and if not, you should critique the lack of research in this area);

6) A description of the role of family and community in addressing addiction issues in general, and in engaging the individual in particular;

7) A careful articulation of the role of the helping professional, including managing subjective reactions to each of the 2 approaches.

It is expected that the student will use an evidence-based registry or review as a starting point for the review and then search the peer reviewed literature for empirical evidence regarding the interventions and engagement specific information. The review can be no more than 15 pages long, and must include a review of 3 studies for each of the approaches. 72 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

APPENDIX 6F: GROUP PAPER AND PRESENTATIONS ON SPECIAL POPULATIONS

● Students should form groups of 2 – 5 individuals;

● Each paper and presentation should address substance abuse engagement, assessment and treatment with a special population. While each work covers the spectrum of engagement, assessment and treatment-the focus should be on engagement. Examples of special populations include but are not limited to people of color, women, men, veterans, older adults, LGBTQ populations, domestic violence survivors, and youth in the child welfare system.

● Each paper should be approximately 10 pages long and address the following:

a. Prevalence of substance abuse among members of the identified group.

b. Knowledge needed to engage, assess & treat members of the identified group, including theoretical and practice approaches.

c. Attitudes needed to engage, assess & treat members of the identified group.

d. Skills needed to engage, assess, & treat the identified group.

e. Special issues that should be considered when attempting to engage individuals in the identified group, including developmental and co-occurring considerations.

f. Other issues you think are influential and relevant to assessment, treatment and ongoing engagement with the identified group but not discussed elsewhere in the paper.

g. Resources (web sites, national and local organizations, special treatment facilities, etc) for members of the identified group.

● Presentations must:

a. Actively involve each member of the group (each member of the group must speak in front of the class in order to get credit for the presentation). Competency 6: Engage With Individuals, Families, Groups, Organizations, and Communities 73

b. At a minimum, address the knowledge, attitude, skills, and cognitive and affective processes required for work with the identified group.

c. Distribute a handout to the instructor and students which includes:

— An outline of the presentation. — A list of the resources provided in the paper.

d. Be 15-20 minutes in length and include additional time for questions and answers.

e. Be professionally presented; students are encouraged to use PowerPoint and other multimedia resources where this will be helpful to the presentation.

APPENDIX 6G: TWELVE-STEP MEETING OBSERVATION & REFLECTION

Instructions:

● Students are to attend at a 12-step meetings. If you currently attend 12-step meetings you should attend a different kind of group than that which you currently attend (for example, if you attend AA, you should go to Al-Anon, NA, or OA meetings).

● Please make sure that the meetings are “Open” meetings unless you specifically identify as a member of the group you are attending. Open groups are typically marked by “O,” which means they are open to the general public (differentiated from a “closed meeting for addicts only”).

Reflection Prompts: ● Document which meeting you attended (location and group name); include type of meeting, time, date and location, number of persons present.

● What was your initial reaction to having to attend a 12-step meeting?

● Describe the order of the meeting and what happened during the meeting. 74 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

● What was the “main topic” of the discussion?

● What was the composition of the group?

● What was the feeling/tone of the members group?

● How did attendees interact among themselves?

● What was your reaction to the attendees in attendance?

● How did you feel at the start, middle, and end of the meeting?

● What surprised you?

● Did the meeting meet your expectations?

● What unanswered questions remained for you? Competency 7 Assess Individuals, Families, Groups, Organizations, and Communities

COMPETENCY DESCRIPTION Social workers working with substance use conduct ongoing systematic biopsychosocial substance use assessments, gather and interpret data at multiple levels, and use a variety of culturally and developmentally appropriate methods (e.g., interviews, direct observations, standardized instruments, and surveys). These methods are used to identify the needs and strengths of individuals, families, groups, organizations, and communities. Social workers influence the delivery of services by assessing substance use and contributing factors such as trauma, adversity, mental health, and co-occurring disorders. Social workers recognize that diagnosis and treatment are affected by stigma, misperceptions related to substance use, and equity and access, which under- scores the importance of ongoing biopsychosocial assessment practices. Social workers use the biopsychosocial assessment model to identify strengths, resiliencies, and cultural relevance to collaboratively identify the necessary interventions while working with diverse individuals, families, groups, organizations, and communities. Social workers recognize the important role of families in treatment and recovery and involve families and all other forms of support. Social workers use evidence-informed assessment practices to determine appropriate intervention strategies, goals, and objectives that are accessible for individuals, families, groups, organizations, and communities.

75 76 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

COMPETENCY BEHAVIORS

● Identify and categorize signs and symptoms of SUDs.

● Demonstrate understanding of evidence-based approaches for diagnosis, screening, assessment, and treatment of SUDs.

● Collect and organize data and apply critical thinking to interpret information from clients and constituencies.

● Apply understanding of SUD theories and models to client systems and circumstances.

● Demonstrate knowledge of resource accessibility and policies at the local, state, national, and global levels.

● Recognize the repercussions of substance use for individuals, families, organizations, and communities.

● Identify and analyze your own values, biases, and assumptions and how they can affect the relationship with a client coping with substance use or behavioral addictions.

● Select appropriate intervention strategies based on the assessment, research knowledge, and values and preferences of clients and constituencies.

● Demonstrate the use of measurement instruments that are culturally and developmentally appropriate for screening and assessment of SUDs.

● Demonstrate the ability to engage all clients in the assessment process by using interviewing skills.

● Assess mental health, trauma, adversities, occurring disorders, and other contributing factors. Competency 7: Assess Individuals, Families, Groups, Organizations, and Communities 77

CURRICULAR RESOURCES MAPPED TO COMPETENCY DIMENSIONS

Readings Resource Competency Dimension

Bartram, M . (2019) . Toward a shared vision for mental health and Knowledge addiction recovery and well-being . Journal of Recovery in Mental Skills Health, 2(2–3), 55–72 . Cognitive and Affective Processes

Brekke, E ., Lien, L ., & Biong, S . (2018) . Experiences of professional helping Knowledge relations by persons with co-occurring mental health and substance Skills use disorders . International Journal of Mental Health and Addiction, 16(1), 53–65 . Cognitive and Affective Processes

Burlew, A . K ., Copeland, V . C ., Ahuama-Jonas, C ,. & Calsyn, D . A . (2013) . Knowledge Does cultural adaptation have a role in substance abuse treatment? Skills Social Work Public Health, 28(1), 440–460 . Cognitive and Affective Processes

Daley, D . C ., & Feit, M . D . (2013) . The many roles of social workers in the Knowledge prevention and treatment of alcohol and drug addiction: A major health Skills and social problem affecting individuals, families, and society . Social Work in Public Health, 28(3–4), 159–164 . Cognitive and Affective Processes

Knight, D . K ., Becan, J . E ,. Landrum, B ., Joe, G . W ., & Flynn, P . M . (2014) . Knowledge Screening and assessment tools for measuring adolescent client needs Skills and functioning in substance abuse treatment . Substance Use & Misuse, 49, 902–918 . Cognitive and Affective Processes

Kourgiantakis, T ., Saint-Jacques, M . C ,. & Tremblay, J . (2017) . Facilitators Knowledge and barriers to family involvement in problem gambling treatment . Skills International Journal of Mental Health and Addiction, 1–22 . https://doi . org/10 .1007/s11469-017-9742-2 Cognitive and Affective Processes

(continued) 78 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

Readings (continued)

Resource Competency Dimension

Kourgiantakis, T ., Sanders, J ., Pont, L ,. McNeil, S ,. & Fang, L . (2017) . Knowledge Adolescent problem gambling. A prevention guide for parents. Centre Skills for Addiction and Mental Health . https://learn .problemgambling . ca/PDF%20library/handbook-prevention-guide-for-parents- Cognitive accessible-2017 .pdf and Affective Processes

Kourgiantakis, T ., & Stark, S . (2015) . Parent problem gambling. A Knowledge prevention guide . Centre for Addiction and Mental Health . https:// Skills learn .problemgambling .ca/PDF%20library/handbook-guide-for- parents-accessible-2017 .pdf Cognitive and Affective Processes

Littrell, J . (2011) . How addiction happens, how change happens, and what Knowledge social workers need to know to be effective facilitators of change . Skills Journal of Evidence-Based Social Work, 8(5), 469–486 . Cognitive and Affective

Miller, W ., & Rollnick, S . (2009) . Ten things that motivational interviewing Knowledge is not . Behavioral and Cognitive Psychotherapy, 37, 129–140 . Skills Cognitive and Affective Processes

Norcross, J . C ., Krebs, P ., & Prochaska, J . O . (2011) . Stages of change . Knowledge Journal of Clinical Psychology: In Session, 67(2), 143–154 . Skills Cognitive and Affective Processes

Skinner, W ., Cooper, C ., & Chamberlain, C . (2013) . Psychotherapy essentials Knowledge to go: Motivational interviewing for concurrent disorders . W . W . Norton Skills & Company . (Comes with a DVD that shows a social worker and client with opioid addiction ). Cognitive and Affective Processes

Tatarsky, A ., & Marlatt, G . A . (2010) . State of the art in harm reduction Knowledge psychotherapy: An emerging treatment for substance misuse . Journal Skills of Clinical Psychology, 66(2), 117–122 .

(continued) Competency 7: Assess Individuals, Families, Groups, Organizations, and Communities 79

Readings (continued)

Resource Competency Dimension

Screening, brief intervention, and referral to treatment (SBIRT) toolkit for Knowledge problem gambling (see Appendix 7A) . Skills Also available at https://learn .problemgambling .ca/PDF%20library/ Cognitive SBIRT-manual-version-2 .0-090418 .pdf and Affective Processes

Learning Activities Resource Competency Dimension

Engaging Clients Knowledge The instructor provides students with content about the strengths model Skills and recovery-oriented approaches to care . Students read the engagement Cognitive scenarios (see Appendix 7B) and respond to the questions in small and Affective groups . Processes

Identifying Skills in a Social Worker–Client Assessment Knowledge Initial Social Work Interview With Emilia Sanchez Skills https://youtu .be/KeYExkAMwo8 Cognitive Watch this 12-minute video and answer the questions on what skills the and Affective social worker used to engage this client (see Appendix 7C) . Processes

Mythbusters Knowledge Read the myths and in small groups research one of those myths and Skills answer the accompanying questions (see Appendix 7D) . Cognitive and Affective Processes

Media Resource Competency Dimension

Podcast Knowledge “Recovery High Schools: Interview with Lori Holleran Steiker, PhD” Skills The Social Work Podcast: http://socialworkpodcast .blogspot . Cognitive com/2016/08/RecoveryHS .html and Affective Processes

(continued) 80 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

Media (continued)

Resource Competency Dimension

Ontario Provincial System Support Program Knowledge Website for problem gambling resources (screening tools) Skills https://learn .problemgambling .ca/eip/screening-assessment Cognitive and Affective Processes

Six Videos on Stories of Addiction Knowledge https://www .thediscoveryhouse .com/05/30/2016/substance-addiction- Skills videos-you-need-see/ Cognitive See Appendix 7E . and Affective Processes

Film Knowledge The Anonymous People Skills 90-minute documentary about social stigma, drug addiction, and 12-step Cognitive programs . and Affective https://www .kanopy .com/product/anonymous-people Processes

Psychosis and Cannabis Knowledge Three-minute video by psychiatrist Dr . Kwame Mackenzie Skills https://www youtube. .com/watch?v=AFNKCHzF9I4 Cognitive and Affective Processes

Initial Social Work Interview With Emilia Sanchez Knowledge https://youtu .be/KeYExkAMwo8 Skills Cognitive and Affective Processes

Motivational Interviewing Videos Knowledge With social worker Wayne Skinner Skills Four Processes of M.I. (5 min 43 sec) Cognitive https://www youtube. .com/watch?reload=9&v=JT9asME0zDc&index and Affective =1&list=PLcgiUg338vSsVXLF0WMa2TqwtWDIORbP6 Processes 5 Core Interviewing Skills (2 min 28 sec) https://www youtube. .com/watch?v=pgtHqPENKMw&list =PLcgiUg338vSsVXLF0WMa2TqwtWDIORbP6&index=8 M.I. Skillful Listening (3 min 56 sec) https://www youtube. .com/watch?v=BfiXyKoAZq4&list =PLcgiUg338vSsVXLF0WMa2TqwtWDIORbP6&index=2 (continued) Competency 7: Assess Individuals, Families, Groups, Organizations, and Communities 81

Media (continued)

Resource Competency Dimension

M.I. Open-ended Questions (1 min 35 sec) https://www youtube. .com/watch?v=Fo4D05z_Bvg&list =PLcgiUg338vSsVXLF0WMa2TqwtWDIORbP6&index=7 M I. . Affirmations (1 min 57 sec) https://www youtube. .com/watch?v=2brUB_bXHYk&list =PLcgiUg338vSsVXLF0WMa2TqwtWDIORbP6&index=6 M.I. Reflections (5 min 17 sec) https://www youtube. .com/watch?v=ipf1qVAESIc&list =PLcgiUg338vSsVXLF0WMa2TqwtWDIORbP6&index=4 M.I. Summaries (1 min 54 sec) https://www youtube. .com/watch?v=WA_rdWQe03M&list =PLcgiUg338vSsVXLF0WMa2TqwtWDIORbP6&index=5 M.I. Providing Information (5 min 48 sec) https://www youtube. .com/watch?v=Gzp3GAi4rPQ&list =PLcgiUg338vSsVXLF0WMa2TqwtWDIORbP6&index=3 M.I. Skillful Listening & Cannabis Use (6 min 50 sec) https://www youtube. .com/watch?v=gDr8dY-kz-8&list =PLcgiUg338vSsVXLF0WMa2TqwtWDIORbP6&index=9

SBIRT Knowledge Online module to train healthcare providers in SBIRT with Appalachian Skills people (2018) .http://cahsmedia2 .uc .edu/host/Appalachian%20Module/ Cognitive story_html5 .html and Affective Online module to train healthcare providers in SBIRT with pregnant Processes women (2017) .http://cahsmedia2 .uc .edu/host/PregnancyModule/story . html

Resources Resource Competency Dimension https://www .cbsnews .com/video/sgb-huntington-wv-game-of-thrones/ Knowledge This is a 60 Minutes program . Skills Cognitive and Affective Processes 82 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

Assignments Resource Competency Dimension

Family-Centered Care Group Video Knowledge See Appendix 7F . Skills Cognitive and Affective Processes

Opioid Addiction Book Review Knowledge Students will select an autobiography of an opioid addict and use Skills concepts of planned change in a 3- to 5-page paper . Cognitive See Appendix 7G . and Affective Processes

Policy on Opioid Reduction Knowledge Students will write an elected official and support the need for a specific Skills policy that aims to reduce opioid use . They will use the NASW Code of Cognitive Ethics to discuss social workers’ important role in opioid use reduction . and Affective See Appendix 7H . Processes

Self-assessment of Preparedness for SUD Practice Knowledge In this assignment you will be asked to complete a reflective self- Skills assessment, incorporating what you have learned about substance abuse Cognitive as it relates to the CSWE competencies . and Affective See Appendix 7I . Processes Many clients are affected by SUDs in some way . This means that even if we do not personally deal with such an issue, chances are we know someone who does . Because social workers provide services to those affected by these disorders, we must reflect on our own professional use of self . This assignment is designed to assess your competency in the CSWE EPAS .

Self-help Meeting Papers Knowledge One must be a 12-step meeting for people in recovery (e g. ,. AA, NA), and Skills one must be for family members (e g. ,. Al-Anon, Nar-Anon, Tough Love) . Cognitive See Appendix 7J . and Affective Processes

Summary and Analysis of EBP Treatment: Paper Knowledge Students will conduct a review of an EBP for SUD treatment that they Skills have been trained in or have an interest in being trained in . They will write Cognitive a 3- to 5-page, APA-formatted paper . and Affective See Appendix 7K . Processes

(continued) Competency 7: Assess Individuals, Families, Groups, Organizations, and Communities 83

Assignments (continued)

Resource Competency Dimension

Abstaining Exercise Knowledge Think about things you do on a regular basis that you enjoy . For this Skills exercise, pick one of them that you are willing to give up for a week . Cognitive Starting Sunday, resolve to give it up for 7 days . It can be anything you and Affective like, such as your favorite food, Facebook, or a behavior you have such as Processes cracking your knuckles . See Appendix 7L .

Field Activities Resource Competency Dimension

Supervision in Field Activity Knowledge See Appendix 7M . Skills Cognitive and Affective Processes

APPENDIX 7A: SBIRT ASSIGNMENTS Select from any of the following:

● Explain skillful listening using MI.

● Develop three examples of open-ended questions that can be used in an assessment.

● Compare affirmations with compliments.

● Develop one example of an affirmation.

● Develop three examples of reflections.

● Describe how summaries can be used in an assessment.

● Describe how a social worker can provide information during an assessment.

● Define skillful listening. 84 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

APPENDIX 7B: ENGAGEMENT SCENARIOS In small groups, discuss how you will engage these clients by using recovery-oriented, strengths-focused, and family-centered approaches. Prepare a response from the social worker in response to the client’s statement. The social worker’s response must show application of the approaches.

1) You are a school social worker and are meeting for the first time with 15-year-old Shanice and her parents, Brenda and Yasmin. They are concerned about Shanice’s alcohol use, and when you ask what made them decide to come see you, Shanice says, “I didn’t want to come, but had no choice. No offense, but I think this is a waste of time.”

How will you engage these clients by using recovery-oriented, strengths-focused, and family-centered approaches?

______

Social worker reply:______

______

Explain your reply:______

______

______Competency 7: Assess Individuals, Families, Groups, Organizations, and Communities 85

2) You are a social worker at a community agency for older adults. You have a client with mobility problems and are doing a home visit to assess Mukesh’s needs. When you arrive, you notice a strong smell of cannabis, but when you ask about Mukesh’s cannabis use, he replies, “I don’t think I smoke too much pot, and it’s the only thing that helps calm me down.”

How will you engage the client by using recovery-oriented, strengths-focused, and family-centered approaches?

______

Social worker reply:______

______

Explain your reply:______

______

3) You are a social worker working in a primary healthcare clinic. The physi- cian in the clinic refers you a 21-year-old client named Miguel. He is in an engineering program and has been put on academic probation because of his low grades. He has high-functioning autism, attention-deficit/hyper- activity disorder, social anxiety, and depression. He has been using a lot of cannabis, vaping, and playing video games during a good part of his 86 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

waking hours. After you explain confidentiality to your client, Miguel smirks, rolls his eyes, and states, “Yeah, I’ve heard it before. It’s confidential until I tell you something important. Then you will tell my parents, my doctor, or the police.”

How will you engage the client by using recovery-oriented, strengths-focused, and family-centered approaches?

______

Social worker reply:______

______

Explain your reply:______

______

APPENDIX 7C: EMILIA SANCHEZ AND SOCIAL WORKER After watching this video showing a social worker conducting a brief assessment with Emilia Sanchez, respond to these questions in small groups: https:// youtu.be/KeYExkAMwo8 Competency 7: Assess Individuals, Families, Groups, Organizations, and Communities 87

1) What skills did the social worker use to engage the client? Provide specific examples from the interview.

______

2) What were the strengths of this assessment and areas to improve?

______

3) Did the social worker use a strengths-focused approach in this assessment? Provide examples of how this was or was not consistent with the strengths model.

______

APPENDIX 7D: MYTHBUSTERS ASSIGNMENT The goal of this assignment is to debunk or challenge the myth you have been given. In small groups, you will research the factors that contribute to this myth and analyze the reasons this myth is false, distorted, a stereotype, or not always true in all cases (not the full picture). Questions 1–7 are completed by the group, and question 8 is completed by each student separately.

Each group will provide answers to the following questions: 88 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

1) Where is this myth coming from? For example, is it a stereotype, an approach, a law, or what?

2) How is this myth perpetuated and by whom?

3) Who is affected by this myth? How are they affected?

4) What is closer to the truth, or what are alternative explanations?

5) How is this myth oppressive for the people affected?

6) Is this myth caused or influenced by policies, laws, values, treatment approaches, or models?

7) How can this myth be eradicated? In society? In treatment? In families?

8) What are your assumptions, values, and biases linked with the statement? How would they affect your assessment and ability to engage a client with substance use concerns or behavioral addictions?

Myths

1) Harm reduction programs encourage people to keep using.

2) For someone with an addiction, abstinence is the only way to get better.

3) Addiction affects only the person with the addiction.

4) Substance addictions are worse than behavioral addictions.

5) Families are codependent and enable the person with the addiction.

6) There is no addictive drug; it is the person who has an addictive personality.

7) Only people with histories of trauma or abuse develop addictions.

8) Most people with addictions are living in poverty.

9) Children are adaptable. A parent’s drinking or substance use doesn’t affect them.

10) Addictions are hereditary. Competency 7: Assess Individuals, Families, Groups, Organizations, and Communities 89

11) Most addiction counselors have had an addiction themselves, and you need to have had an addiction to work well with people who have an addiction.

12) Involving families in addiction can sometimes be worse for the person with the addiction because these families have conflictual relationships, and it does not help recovery.

13) It is mostly men who develop addiction problems.

14) It doesn’t matter what type of service, approach, or treatment is given, if the person with the addiction isn’t ready to make a change, the format or type of intervention is irrelevant.

APPENDIX 7E: STORIES ON ADDICTION The Discovery House has videos on different aspects of addiction. Here are three videos:

These Babies Were Born Addicted to Drugs

Each year, thousands of babies are being born addicted to opiates, and the problem hasn’t shown signs of getting any better. Women who are addicted before conceiving continue their opiate abuse throughout their pregnancy, and this video demonstrates the severity of this growing problem. It’s sad and disturbing, but it shines a light on a subject that doesn’t get much attention.

The Power of Vulnerability

Brene Brown went on a quest to better understand something that we are all familiar with: shame. She talks about the link between shame, vulnerability, and the fear of disconnection, which she believes to be directly linked to some of the reasons that someone might start to develop a substance use disorder.

Jodie Sweetin: From Addiction to Recovery to “Fuller House” 90 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

When Full House ended its 8-year run on ABC in 1995, Sweetin was just 14 years old. For someone who grew up on the set and in the spotlight from a very young age, it was a shock to be unemployed and separated from her onscreen family. Her life was chaos, and so she began drinking and later using crystal meth to cope. As a celebrity advocate for recovery, Sweetin has always been open and has shared her story at events nationwide regarding her experience with addiction. She continues to help others through the struggle and stigma of addiction.

APPENDIX 7F: FAMILY-CENTERED PRACTICES IN ADDICTIONS GROUP PRESENTATION Students will work in groups of three or four and identify a case of a family affected by the substance use or behavioral addiction concerns of a significant other that one of the group members has worked with at practicum. Groups will create a 15-minute video that shows part of a social worker and family member assessment session. The group will present this video to the class and do a 15-minute presentation that is a critical analysis of the social worker–family member assessment session.

Video shows the following:

● Social worker assesses how the family members have been affected by their loved one’s substance use.

● Social worker assesses strengths, supports, self-care, and coping strategies.

● Social worker provides family members with psychoeducation on one of these areas:

— information about substance use concerns (diagnosed or not)

— impact or adverse effects of substance use on individuals and families

— treatment and services for people with substance use or behavioral addictions

— importance of self-care for families Competency 7: Assess Individuals, Families, Groups, Organizations, and Communities 91

● Social worker demonstrates skills that facilitate alliance building.

— Some important concepts and skills: empathy, open-ended questions, affirmations, reflections, validation, empowerment, eliciting hope, and being nonjudgmental

● Social worker demonstrates use of the following approaches or models in the assessment: recovery orientation, harm reduction, strengths focus, family-centeredness, cultural attunement, and sensitivity.

Presentation includes the following:

● Analysis of the degree to which the above points were demonstrated in the social worker–family member assessment

● Analysis of the impact of addictions on this family member and others in this family

● Analysis of this family member’s understanding of addictions and how culture and diversity factors affect this experience

● Analysis of the barriers and facilitators to treatment and recovery for this family member and his or her significant other

● Analysis of the stage of change for this family member (and the significant other) and how it affected the interview

● Discussion of this family’s strengths and coping skills

APPENDIX 7G: OPIOID BOOK REVIEW Students will choose an autobiography that relates to opioid addiction. Students may choose from those listed below. Students may choose an autobiography that is not listed but must obtain prior permission of the instructor. You are expected to read the book and write a 3- to 5-page paper that includes the following:

a. A brief description of a major character in terms of age, personality, race, class, ethnicity, ability, sexual orientation, religious preference, and gender (discuss what is known about the character). Discuss their environment (family, friends, neighborhood-as it relates to drug use). 92 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

b. A description of the progression of the addiction (onset of use to full dependency) by including symptoms, situations, and crises that relate to addiction.

c. A description of the similarities and differences between you and the chosen character in terms of human development, values, educational and vocational opportunity, family of origin, supports, and environment.

d. A discussion of the challenges you would face in confronting your own biases, assumptions, and values if this character were a client assigned to you. What treatment would you prescribe and why? Include a reflection on the Code of Ethics and Competency Standards.

e. Discuss policy implications as they relate to the story (criminalization, treatment access, stigma, location-specific stats such as where is the character from and what the drug problem is like in this area).

Specifically, students will process their observations of the course content and be able to identify and discuss the impacts opioid use has on the individual, family, community, and organizations. Research and discussion of policy will be included in this paper. A 3- to 5-page paper in APA format is required. Books to choose from: Permanent Midnight by Jerry Stahl, Junkie by William S. Burroughs, Saving Jake: When Addiction Hits Home by D’Anne Burwell, Heroin, Hurricane Katrina, and the Howling Within: An Addiction Memoir by Eliza Player, Marlena by Julie Buntin, Painkiller Addict: From Wreckage to Redemption—My True Story by Cathryn Kemp, Pill Head: The Secret Life of a Painkiller Addict by Joshua Lyon, Defining Moments: A Suburban Father’s Journey Into His Son’s Oxy Addiction by Bradley DeHaven, My Fair Junkie: A Memoir of Getting Dirty and Staying Clean by Amy Dresner, and What I Couldn’t Tell You: One Man’s Struggle with Opioid Addiction by Matthew Edwards. Competency 7: Assess Individuals, Families, Groups, Organizations, and Communities 93

APPENDIX 7H: POLICY ASSIGNMENT Write your state representative.

1) Locate a representative you want to contact (e.g., a legislator or governor).

2) Choose a policy or policies that you think will curtail the trend of opioid use in your state.

3) Use data from the semester readings to support your claim that your state needs to implement this policy.

4) Share the value of supporting the employment of social workers in the state. (Use NASW policy and Code of Ethics.)5. Comment on two other letters if used as a discussion board.

APPENDIX 7I: SELF-ASSESSMENT OF PREPAREDNESS FOR SUD PRACTICE

Overview

In this assignment you will be asked to complete a reflective self-assessment, incorporating what you have learned thus far in the course and the biopsychosocial approach.

Purpose

Many clients are affected by SUDs in some way. This means that whether we personally deal with such a problem, chances are we know someone who does. Because social workers provide services to those affected by these disorders, we must reflect on our own professional use of self. This assignment is designed to assess your competency with course objectives 2 and 3 and CSWE EPAS standards X, Y, and Z.

Rubric

This assignment will be graded on a 0- to 15-point scale (or 15% of your final grade) according to the rubric below. 94 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE (continued) 13–15 POINTS 13–15 Prompts are are Prompts comprehensively addressed, student demonstrates a clear of understanding who she or he is beliefs and what she or he holds about mental health . APA format is format APA no followed, or misspellings grammatical . errors and Forethought are proofreading . evident 10–12 POINTS 10–12 Relevant Relevant information in is provided introduction, including specifics . A clear picture of the student . is provided minor Very occurrences of missing . information Assignment Assignment minor contains (1 occurrence) or conceptual organizational lack of flaws, forethought, grammar, spelling, or structural . errors 7–9 POINTS 7–9 Relevant Relevant information about introduction, beliefs, and is reflection . More provided is information a needed for picture clearer and of student beliefs . Assignment Assignment contains (2 or 3 few occurrences) or conceptual organizational lack of flaws, forethought, grammar, spelling, or . errors structural 4–6 POINTS Student Student provides basic very for information introduction, beliefs, and . reflection Assignment Assignment contains multiple (4 occurrences) or conceptual organizational lack of flaws, forethought, grammar, spelling, or . errors structural 1–3 POINTS 1–3 Introduction, Introduction, beliefs, or reflection is missing, although some brief is information . provided Assignment Assignment contains (5 repetitive occurrences) or conceptual organizational lack of flaws, forethought, grammar, spelling, or . errors structural . 0 POINTS This section is section This or very missing unclear Paper is unclear Paper . or disorganized Assignment contains excessive than 6 (more occurrences) or conceptual organizational lack of flaws, forethought, grammar, spelling, or . errors structural Rubric for Self-assessment of Preparedness for Mental Health Practice Mental for of Preparedness Self-assessment Rubric for Introduction Introduction and reflection Overall Overall quality: style, APA grammar, mechanics, spelling, organization, sentence structure POINTS OR % EARNED POINTS Assessment Assessment Criteria Competency 7: Assess Individuals, Families, Groups, Organizations, and Communities 95 13–15 POINTS 13–15 Student fully Student his or incorporates her understanding of current biopsychosocial and spiritual assessments, includes what she or he would them, and add to concise a clear, is conclusion included, tying all together . prompts Student fully Student incorporates experiences, biases, strengths, and barriers his or her to with work future health . mental are Prompts comprehensively . addressed 10–12 POINTS 10–12 Relevant Relevant information about assessments, including what the student add to would them, ideas for practice, future and a clear is conclusion, with provided, minor very occurrences of missing or unclear . information Relevant Relevant information about prompts . is provided minor Very occurrences of missing or unclear . information 7–9 POINTS 7–9 Relevant Relevant information about assessments, including what the student add to would them, ideas for practice, future and a clear is conclusion, . More provided is information a needed for picture clearer of student’s ideas . Relevant Relevant information about strengths is and barriers . More provided is information a needed for picture clearer of experiences or biases .

. . 4–6 POINTS Minimal assessment reflection and ideas are more presented; is information a needed for comprehensive of student’s view understanding of the assessment and process ideas for practice future Conclusion is unclear or incomplete Minimal and strengths are barriers acknowledged; more is information a needed for comprehensive of view and experience . preparedness (continued) 1–3 POINTS 1–3 Either assessment aspects or future ideas practice missing, are although some brief is information . No provided clear conclusion . is provided Either strengths Either strengths or barriers not are acknowledged, minimal understanding of how experience affects . preparedness . . 0 POINTS This section is section This or very missing unclear This section is section This or very missing unclear Assessments Assessments and future practice Strengths and Strengths barriers POINTS OR % EARNED POINTS Assessment Assessment Criteria Rubric for Self-assessment of Preparedness for Mental Health Practice Mental for of Preparedness Self-assessment Rubric for 96 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

Format

Your Self-Assessment Assignment should consist of four parts. Limit your work to 5 pages of content and use APA formatting.

Part 1: Introduction and Reflection on Experience Identify your personal beliefs about and experiences with SUDs. It is important to note that we are not requiring self-disclosure here. You have the right to your privacy, and the purpose of this section is to assist you with self-assessment. Your responses will be kept confidential, within limits of confidentiality according to the NASW Code of Ethics. This section should be preceded by an introduction to the assignment and a purpose statement. Suggested length: 1–2 pages.

Writing Prompts (Note: These are not subheadings. Do not write each of these prompts in your narrative and then respond. They are meant to guide you in the completion of the assignment.)

● How were your beliefs about SUDs formed?

● How did your experiences shape your view of these disorders or the current SUD treatment system?

● What has shaped your view of “normal” or “abnormal” with regard to substance use?

Part 2: Experiences as Strengths How will your self-reflection, beliefs, and experiences with SUDs and the SUD treatment system improve your practice with clients as a social worker? Suggested length: 2–3 paragraphs.

Writing Prompts

● Will you use self-disclosure, and if so, to what degree?

● How will you practice professional boundaries in your work with clients? Competency 7: Assess Individuals, Families, Groups, Organizations, and Communities 97

Part 3: Biases as Barriers How might your personally held beliefs, experiences, or biases affect your practice with these clients as a social worker? It is important to note that we all have biases, and being aware of one’s own biases is an essential part of competent social work practice. Suggested length: 3–4 paragraphs.

Writing Prompts

● If you are currently working in the field or completing an internship, what conflicts have arisen that required you to examine your personal biases?

● If you are not currently working in the field or completing an internship, what areas of practice or types of clients do you anticipate being faced with that will require examination of your personal biases?

● In what ways are you working to minimize the effect these biases and experiences may have on practice?

Part 4: Biopsychosocial Assessments and Ideas for Future Practice Considering the biopsychosocial assessment that was introduced in the text, how do you envision using this in your social work practice? A conclusion should follow this area, tying together your self-reflective piece and referring to your purpose statement. Suggested length: 1 page.

Writing Prompts

● What do you think is the most important aspect of a biopsychosocial assessment?

● What would you add to a biopsychosocial approach for a more complete assessment of clients with SUDs? 98 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

APPENDIX 7J: SELF-HELP GROUP PAPERS

Self-help Meeting Papers

This includes the following (10 points each):

Select two open (or closed if you qualify for membership) alcohol- or drug-related self-help meetings to attend.

● One must be a 12-step meeting for people who are in recovery (e.g., AA, NA).

● One must be for family members (e.g., Al-Anon, Nar-Anon, Tough Love). The meetings should be of a type you have not previously attended. For example, if you have attended AA meetings in the past, you should not attend the same AA meeting for this assignment.

Take notes after the meeting (not during) to summarize the content (e.g., themes, content, materials, being sure to protect confidentiality of the meetings) and process (how the meeting was run), as well as your reactions to the meeting. If you don’t take these notes, you’ll have a hard time writing the paper later.

After attending the selected meeting, write a brief paper (2–3 pages maxi- mum for each meeting) that address the following points:

1) A description of the meeting’s content and process (generally, without violating anonymity).

2) Describe how the character of the 12-step meetings you selected seemed to fit (or not) with what you had anticipated.

3) Describe how the values and principles of the meetings you attended fit or don’t fit with social work values.

4) What were you feeling and thinking during the week, knowing you were going to have to attend the meeting.

5) Convey your thoughts and feelings about the meeting (before, during, and after) and insights you experienced as a result of the meetings. Competency 7: Assess Individuals, Families, Groups, Organizations, and Communities 99

6) Based on your experience, what do you think might make it less stress- ful for a client to attend their first meeting?

7) Discuss your comfort with recommending the organization to clients or their family members.

8) In the Al-Anon paper, add a brief section that compares both meetings on similarities and differences.

APPENDIX 7K: SUMMARY AND ANALYSIS EBP TREATMENT PAPER Conduct a review of an EBP for substance use disorder treatment that you have been trained in or have an interest in being trained in.

Describe the practice in detail, including the population and setting it serves (include the sources for this information).

Conduct a literature review, including at least three articles that describe the benefits of this practice to clients and the data and research that support this practice.

Describe how practitioners are trained in this EBP, what is required, where it can be obtained, and sources (e.g., books, website, trainers).

Discuss any possible strengths, weaknesses, or challenges of using this EBP with clients as noted in the literature.

This paper should be 3 pages long, not counting a reference page, using APA format.

APPENDIX 7L: ABSTAINING EXERCISE Think about things you do on a regular basis that you enjoy. For this exercise, pick one of them that you are willing to give up for a week. Starting Sunday, resolve to give it up for 7 days. It can be anything you like, such as your favorite food, Facebook, or a behavior you have, such as cracking your knuckles.

1) Fill out the following chart each time you have an urge for the thing you are giving up. You can put the chart on an index card for every day and 100 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

fill it out that way, or you can extend the chart to have as many lines as you need for the week.

2) Once you have done this for the day, rate how hard or easy it was to get through the day giving something up that you enjoy (1 = no problem; 5 = moderate challenge; 10 = really hard).

Sunday 1 2 3 4 5 6 7 8 9 10

Monday 1 2 3 4 5 6 7 8 9 10

Tuesday 1 2 3 4 5 6 7 8 9 10

Wednesday 1 2 3 4 5 6 7 8 9 10

Thursday 1 2 3 4 5 6 7 8 9 10

Friday 1 2 3 4 5 6 7 8 9 10

Saturday 1 2 3 4 5 6 7 8 9 10

3) At the end of the week, write a page or two that addresses what this experience was like for you. Was it easy or hard? What surprised you? Did you ask for help from anyone? Why or why not? Did it get harder or easier over time? Include your thoughts on how your experience might have some similarities to clients seeking treatment for SUDs. Include your rating scale of 1–10 for the week on a separate sheet of paper.

SITUATION EXAMPLE THOUGHTS FEELINGS OUTCOME

Example: Want to Oh no, I can’t Angry, Found Resting on check FB do that . I deprived something couch hate this else to do restriction!! instead Competency 7: Assess Individuals, Families, Groups, Organizations, and Communities 101

A cognitive–behavioral therapy (CBT) technique that makes it easier for some people to understand the sequence that leads up to the behavior involves a scale from 1 to 10 in which 10 is the ultimate expression of the behavior (e.g., the drink or the temper tantrum). Starting at the lower end of the scale, go through the scale and identify the escalating triggers of the behavior.

Example: Why did I eat that chocolate?

Feeling sad Angry Feeling neglected Eat it

1 2 3 4 5 6 7 8 9 10

Long, hard day at work Feeling frustrated with all I have to do Don’t feel supported by boss What difference will it make? I deserve it!!

APPENDIX 7M: FIELD ACTIVITY 1) Student discusses with his or her supervisor at the field placement SUD assessments and tools used at the agency.

2) Depending on the student’s skills and needs, he or she:

● Receives orientation or training. ● Reviews files from other clinicians (if appropriate). ● Sits in on assessments by other clinicians (if appropriate).

3) Student incorporates knowledge into SUD assessments with clients at the agency, under the supervision of the field instructor.

4) Instructor uses supervision time to discuss the student’s integration of knowledge and skills and reviews his or her documentation of the assessment.

Possible readings to incorporate:

Diagnostic and Statistical Manual of Mental Disorders (DSM–5)

ASAM Criteria

Motivational Interviewing: Preparing People to Change Addictive Behavior

Competency 8 Intervene With Individuals, Families, Groups, Organizations, and Communities

COMPETENCY DESCRIPTION Social workers are knowledgeable about the theories and models regarding the prevention, etiology, and treatment of SUDs and related issues and the level of empirical evidence that exists for each. They draw on theory, biopsychosocial assessment, diagnosis (when indicated), and treatment goals to select and implement evidence-supported interventions regarding substance use and associated problems with individuals and families. They are knowledgeable about group work specific to substance use treatment settings and deliver appropriate group interventions. They match the level of care for treatment according to the client’s needs and social functioning. They recognize the intersection of physical and mental health issues with substance use and understand the interplay of substance use and associated behaviors that may require complex intervention strategies. Social workers consider pertinent theory; client characteristics; intersecting health, mental health, and addiction issues; client motivation and readiness for change; and client needs and desires to implement best interventions in accordance with their goals and available resources. They are skilled in substance use treatment and current evidence-supported interventions, including medication-assisted treatment and harm reduction strategies. Social workers are knowledgeable about the integration of technology in intervention at the micro, mezzo, and macro levels. Social workers are aware of community-based supports and mutual help groups and can refer clients to them as appropriate. They work with clients to enhance the quality of individual, family, and community well-being in order to facilitate recovery.

103 104 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

Social workers collaborate with stakeholders and constituencies in organizations and communities to identify risk and protective factors for substance use and associated problems in the system and identify structural factors and processes that may contribute to problematic substance use. They engage stakeholders and constituencies to develop prevention and intervention strategies to improve systemic functioning and enhance health. Social workers are leaders in shaping organizational and social policy to enhance social and environmental justice in order to promote systemic conditions of health and recovery. Social workers evaluate individuals’ and systems’ progress on goals and use ongoing assessment to adjust prevention and intervention strategies.

COMPETENCY BEHAVIORS

● Apply theoretical and empirical knowledge of the complex biopsychosocial factors that contribute to problematic substance use behaviors to deliver culturally sensitive, holistic, multilevel intervention and prevention programs.

● Identify evidence-supported interventions for substance use problems relevant to the client’s strengths, needs, co-occurring conditions, and behaviors and implement the best practice option.

● Implement evidence-supported and culturally relevant family interventions to ameliorate substance misuse in the family and the impact of substance misuse on the family system.

● Select and implement group-based interventions to prevent or reduce substance use problems, including referrals to community-based peer support and mutual help groups.

● Evaluate the impact of social conditions on substance use behaviors and advocate for social change and social policies that will prevent and reduce substance use problems. Competency 8: Intervene With Individuals, Families, Groups, Organizations, and Communities 105

CURRICULAR RESOURCES MAPPED TO COMPETENCY DIMENSIONS

Readings Resource Competency Dimension ARTICLES

Ainscough, T . S ., McNeill, A ., Strang, J ., Calder, R ., & Brose, L . S . (2017) . Knowledge Contingency management interventions for non-prescribed drug use Skills during treatment for opiate addiction: A systematic review and meta- analysis . Drug and Alcohol Dependence, 178, 318–339 .

Aldridge, A . A ., Linford, R ., & Bray, J . (2017) . Substance use outcomes Knowledge of patients served by a large US implementation of screening, brief Skills intervention, and referral to treatment (SBIRT) . Addiction, 112 (suppl . 2), 43–53 . https://onlinelibrary wiley. .com/doi/epdf/10 .1111/add .13651

Amaro, H . (2014) . Implementing mindfulness-based relapse prevention in Knowledge diverse populations: Challenges and future directions . Substance Use Skills and Misuse, 49, 612–616 .

Bahorik, A ., Queen, C ., Chen, S ,. Foster, L . J . J ., & Bangs, R . (2015) . Knowledge Racial disparities in community outcomes among individuals with Values schizophrenia and co-occurring substance use disorders . Journal of Social Work Practice in the Addictions, 15, 165–184 . Cognitive and Affective Processes

Beck, A . K ., Forbes, E ., Baker, A . L ,. Kelly, P . J ., Deane, F . P ., Shakeshaft, A ., . Knowledge . . Kelly, J . F . (2017) . Systematic review of SMART Recovery: Outcomes, Skills process variables, and implications for research . Psychology of Addictive Behaviors, 31(1), 1–20 .

Begun, A . L ., Clapp, J . D ., & Alcohol Misuse Grand Challenge Collective . Knowledge (2016) . Reducing and preventing alcohol misuse and its consequences: Skills A grand challenge for social work . International Journal of Alcohol and Drug Research, 5(2), 73–83 . http://www .ijadr .org/index .php/ijadr/ article/view/223

Best, D ., Savic, M ., Mugavin, J ., Manning, V ., & Lubman, D . I . (2016) . Knowledge Engaging with 12-Step and other mutual aid groups during and after Values treatment: Addressing workers’ negative beliefs and attitudes through training . Alcoholism Treatment Quarterly, 34, 303–314 . Skills Cognitive and Affective Processes

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Readings (continued)

Resource Competency Dimension

Brown, A . R . (2018) . A systematic review of psychosocial interventions in Knowledge treatment of opioid addiction . Journal of Social Work Practice in the Skills Addictions, 18, 249–269 .

Brownson, R . C ., Allen, P ., Jacob, R . R ,. Harris, J . K ,. Duggan, K ,. Hipp, P . Knowledge R ., & Erwin, P . C . (2015) . Understanding mis-implementation in public Values health practice . American Journal of Preventive Medicine, 48, 543–551 . Skills

Calhoun, S ., Conner, E ., Miller, M ., & Messina, N . (2015) . Improving the Knowledge outcomes of children affected by parental substance abuse: A review of randomized controlled trials . Substance Abuse and Rehabilitation, 6, 15–24 .

Cao, D ., Marsh, J . C ., Shin, H -C. ., & Andrews, C . M . (2011) . Improving Knowledge health and social outcomes with targeted services in comprehensive Skills substance abuse treatment . American Journal of Drug & Alcohol Abuse, 37, 250–258 .

Carroll, K . M ., Ball, S . A ,. Martino, S ., Nich, C ., Babuscio, T . A ., & Rounsaville, Knowledge B . J . (2009) . Enduring effects of a computer-assisted training program Skills for cognitive behavioral therapy: A 6-month follow-up of CBT4CBT . Drug and Alcohol Dependence, 100, 178–181 .

Clarke, P . B ., Giordano, C . S ., Cashwell, C . S ,. & Lewis, T . F . (2013) . The Knowledge straight path to healing: Using motivational interviewing to address Values spiritual bypass . Journal of Counseling and Development, 91, 87–94 . Skills

Cody, P ., Holleran-Steiker, L . K ., & Szymandera, M . L . (2011) . Equine Knowledge therapy: Substance abusers’ “healing through horses ”. Journal of Social Values Work Practice in the Addictions, 11, 198–204 .

Dennis, C . B ., & Earleywine, M . (2013) . Assessing the attitudes substance Knowledge abuse professionals have toward 12-Step culture: Preliminary results . Values Journal of Social Work Practice in the Addictions, 13, 373–392 .

Dowling, N . A ., Merkourkis, S . S ,. & Lorains, F . K . (2016) . Interventions for Knowledge comorbid problem gambling and psychiatric disorders: Advancing a Skills developing field of research . Addictive Behaviors, 58, 21–30 .

Dugosh, K ., Abraham, A ., Seymour, B ., McLoyd, K ., Chalk, M ., & Festinger, Knowledge D . (2016) . A systematic review on the use of psychosocial interventions Skills in conjunction with medications for the treatment of opioid addiction . Journal of Addiction Medicine, 10(2), 93–103 .

(continued) Competency 8: Intervene With Individuals, Families, Groups, Organizations, and Communities 107

Readings (continued)

Resource Competency Dimension

Echeburúa, E ., Amor, P . J ., & Gómez, M . (2017) . Current psychological Knowledge therapeutic approaches for gambling disorder with psychiatric Skills comorbidities: A narrative review . Salud Mental, 6, 299–305 .

Edmond, M . B ., Aletraris, L ., Paino, M ,. & Roman, P . M . (2015) . Treatment Knowledge strategy profiles in substance use disorder treatment programs: A Skills latent class analysis . Drug and Alcohol Dependence, 153, 109–115 .

Eng, P . (2019) . Theorizing a more radical approach to addiction through Knowledge the lens of participatory spirituality . Addiction Research & Theory . Values https://doi .org/10 .1080/16066359 .2019 .1571190 Skills Cognitive and Affective Processes

Friedrichs, A ., Spies, M ., Härter, M ,. & Buchholz, A . (2016) . Patient preferences Knowledge and shared decision making in the treatment of substance use disorders: A Skills systematic review of the literature . PLoS ONE, 11(1), 0145817 .

Galanter, M . (2018) . Combining medically assisted treatment and Twelve- Knowledge Step programming: A perspective and review . American Journal of Drug Skills and Alcohol Abuse, 44, 151–159 . https://www .tandfonline .com/doi/ pdf/10 .1080/00952990 .2017 .1306747?needAccess=true&

Garland, E . L ., & Howard, M . O . (2018) . Mindfulness-based treatment of Knowledge addiction: Current state of the field and envisioning the next wave Skills of research . Addiction Science & Clinical Practice, 13, 14 . https://doi . org/10 .1186/s13722-018-0115-3

Grant, S ., Colaiaco, B ., Motala, A ., Shanman, R ., Booth, M ,. Sorbero, M ,. & Knowledge Hempel, S . (2017) . Mindfulness-based relapse prevention for substance Skills use disorders: A systematic review and meta-analysis . Journal of Addiction Medicine, 11, 386–396 .

Gustafson, D . H ., McTavish, F . M ., Chih, M ., Atwood, A . K ., Johnson, R . A ., Knowledge Boyle, M . G ., . . . Shah, D . (2014) . A smartphone application to support Values recovery from alcoholism: A randomized clinical trial . JAMA Psychiatry, 71, 566–572 . Skills

Haegerich, T . M ., Paulozzi, L . J ., Manns, B . J ., & Jones, C . M . (2014) . Knowledge What we know and don’t know, about the impact of state policy and Values systems-level interventions on prescription drug overdose. Drug and Alcohol Dependence, 145, 34–47 . Skills Cognitive and Affective Processes

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Readings (continued)

Resource Competency Dimension

Hanhardt, C . B . (2018) . “Dead addicts don’t recover”: ACT UP’s needle Knowledge exchange and the subjects of queer activist history . GLQ: A Journal of Values Lesbian and Gay Studies, 24, 421–444 . Cognitive and Affective Processes

Hawkins, J . D ., Shapiro, V . B ., & Fagan, A . A . (2010) . Disseminating Knowledge effective community prevention practices: Opportunities for social work Skills education . Research on Social Work Practice, 20, 518–527 .

Jhanjee S . (2014) . Evidence based psychosocial interventions in substance Knowledge use . Indian Journal of Psychological Medicine, 36(2), 112–118 . Values

Kelly, J . F ., Hoeppner, B ., Stout, R . L ., & Pagano, M . (2012) . Determining the Knowledge relative importance of the mechanisms of behavior change within Alcoholics Values Anonymous: A multiple mediator analysis . Addiction, 107, 289–299 .

Kolodny, A ., Courtwright, D . T ., Hwang, C . S ., Kreiner, P ., Eadie, J . L ., Clark, Knowledge T . W ., & Alexander, G . C . (2015) . The prescription opioid and heroin Values crisis: A public health approach to an epidemic of addiction, Annual Review of Public Health, 36, 559–574 . Skills Cognitive and Affective Processes

Kumpfer, K ., Magalhães, C ,. & Xie, J . (2017) . Cultural adaptation and Knowledge implementation of family evidence-based interventions with diverse Values populations . Prevention Science, 18, 649–659 . Skills Cognitive and Affective Processes

Kumpfer, K . L ., Whiteside, H . O ., Greene, J . A ,. & Allen, K . C . (2010) . Knowledge Effectiveness outcomes of four age versions of the Strengthening Skills Families Program in statewide field sites . Group Dynamics: Theory, Research, and Practice, 14(3), 211–219 .

Lee, H . S ., Engstrom, M ,. & Petersen, S . R . (2011) . Harm reduction and Knowledge 12 steps: Complementary, oppositional or something in between . Values Substance Use & Misuse, 46, 1151–1161 . Skills Cognitive and Affective Processes

(continued) Competency 8: Intervene With Individuals, Families, Groups, Organizations, and Communities 109

Readings (continued)

Resource Competency Dimension

Leeman, J ., Calancie, L ., Hartman, M . A ., Escoffery, C . T ., Herrmann, Knowledge A . K ., Tague, L . E ., & Samuel-Hodge, C . (2015) . What strategies are Skills used to build practitioners’ capacity to implement community- based interventions and are they effective? A systematic review . Cognitive Implementation Science, 10, 80 . and Affective Processes

Levy, S . J ., Williams, J . F ., & Committee on Substance Use and Prevention . Knowledge (2016) . Substance use screening, brief intervention, and referral Skills to treatment . Pediatrics, 138(1), e20161211 . https://pediatrics . aappublications .org/content/pediatrics/138/1/e20161211 .full .pdf

Liddle, H . A . (2016) . Multidimensional family therapy: Evidence base Knowledge for transdiagnostic treatment outcomes, change mechanisms, and Skills implementation in community settings . Family Process, 55, 558–576 . Cognitive and Affective Processes

Littrell, J . (2011) . How addictions happen, how change happens, and what Knowledge social workers need to know to be effective facilitators of change . Values Journal of Evidence-Based Social Work, 8, 469–486 . Skills Cognitive and Affective Processes

Littrell, J . (2017) . Expanding access to medication assisted treatment: The Knowledge U .S . government’s response to the current heroin epidemic. Social Work Values in Mental Health, 15, 209–229 . Skills Cognitive and Affective Processes

Magill, M ., Stout, R . L ., & Apodaca, T . R . (2013) . Therapist focus on Knowledge ambivalence and commitment: A longitudinal analysis of motivational Values interviewing treatment ingredients . Psychology of Addictive Behaviors, 27, 754–762 . Skills

Marsch, L . A ., Carroll, K . M ., & Kiluk, B . D . (2014) . Technology-based Knowledge interventions for the treatment and recovery management of substance Values use disorders: A JSAT special issue . Journal of Substance Abuse Treatment, 46(1), 1–4 . Skills Cognitive and Affective Processes

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Readings (continued)

Resource Competency Dimension

Marsh, J . C ., Cao, D ., Guerrero, E ., & Shin, H -C. . (2009) . Need-service Knowledge matching in substance abuse treatment: Racial/ethnic differences . Skills Evaluation & Program Planning, 32(1), 43–51 .

McCabe, H . A ., & Wahler, E . A . (2016) . The Affordable Care Act, substance Knowledge use disorders and low-income clients: Implications for social work . Values Social Work, 61, 227–233 . Skills Cognitive and Affective Processes

McPherson, S . M ., Burduli, E ,. Smith, C . L ., Herron, J ., Oluwoye, O ., Hirchak, Knowledge K ., . . . Roll, J . M . (2018) . A review of contingency management for the Values treatment of substance-use disorders: Adaptation for underserved populations, use of experimental technologies, and personalized Skills optimization strategies . Substance Abuse and Rehabilitation, 9, 43–57 . Cognitive https://www .ncbi .nlm .nih .gov/pmc/articles/PMC6095117/ and Affective Processes

Melemis, S . M . (2015) . Relapse prevention and the five rules of recovery . Knowledge Yale Journal of Biology and Medicine, 88(3), 325–332 . Skills

Merkouris, S . S ., Thomas, S . A ., Browning, C . J ., & Dowling, N . A . (2016) . Knowledge Predictors of outcomes of psychological treatments for disordered gambling: A systematic review . Clinical Psychology Review, 48, 7–31 .

Naqvi, N . H ., & Morgenstern, J . (2015) . Cognitive neuroscience approaches Knowledge to understanding behavior change in alcohol use disorder treatments . Skills Alcohol Research: Current Reviews, 37(1), 29–38 .

Neger, E . M ., & Prinz, R . J . (2015) . Interventions to address parenting Knowledge and parental substance abuse: Conceptual and methodological Skills considerations . Clinical Psychology Review, 39, 71–82 .

Novins, D . K ., Croy, C . D ., Moore, L . A ., Rieckman, T . (2016) . Use of Knowledge evidence-based treatment in substance abuse treatment programs Values serving American Indian and Alaska Native communities . Drug and Alcohol Dependence, 161, 214–221 . Skills Cognitive and Affective Processes

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Readings (continued)

Resource Competency Dimension

O’Farrell, T . J ., Schumm, J . A ,. Murphy, M . M ., & Muchowski, P . M . (2017) . Knowledge A randomized clinical trial of behavioral couples therapy versus Skills individually-based treatment for drug-abusing women . Journal of Consulting and Clinical Psychology, 85, 309–322 .

O’Hare, T ., & Sherrer, M . (2012) . Substance use motives in people with Knowledge severe mental illness: Comparisons among four diagnostic groups . Values Journal of Social Work Practice in the Addictions, 12, 370–390 . Skills Cognitive and Affective Processes

Olsson, K . L ., Cooper, R . L ,. Nugent, W . R ., & Reid, R . C . (2016) . Addressing Knowledge negative affect in substance use relapse prevention . Journal of Human Skills Behavior in the Social Environment, 26, 2–14 .

Pade, P ., Fehling, P ., Collins, S ., & Martin, L . (2017) . Opioid overdose Knowledge prevention in a residential care setting: Naloxone education and Values distribution . Substance Abuse, 38(1), 113–117 . Skills

Peele, S . (2016) . People control their addictions: No matter how much Knowledge the “chronic” brain disease model of addiction indicates otherwise, we Values know that people can quit addictions—with special reference to harm reduction and mindfulness, Addictive Behaviors Reports, 4, 97–101 . Skills Cognitive and Affective Processes

Penberthy, J . K ., Konig, A ., Gioia, C . J ., Rodríguez, V . M ., Starr, J . A ., Meese, Knowledge W ., . . . Natanya, E . (2015) . Mindfulness based relapse prevention: Skills History, mechanisms of action, and effects . Mindfulness, 6, 151–158 .

Petry, N . M ., Rash, C . J ., & Alessi, S . M . (2016) . A randomized controlled Knowledge trial of brief interventions for problem gambling in substance abuse Skills treatment patients . Journal of Consulting Clinical Psychology, 84, 874–886 .

Ramsey, A . T . (2015) . Integration of technology-based behavioral health Knowledge interventions in substance abuse and addiction services . International Skills Journal of Mental Health and Addiction, 13, 470–480 .

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Readings (continued)

Resource Competency Dimension

Samson, J . E ., & Tanner-Smith, E . E . (2015) . Single-session alcohol Knowledge interventions for heavy drinking college students: A systemic review Skills and meta-analysis . Journal of Studies on Alcohol and Drugs, 76, 530–543 .

Sayegh, C . S ., Huey, S . J . Jr ., Zara, E . J ., & Jhaveri, K . (2017) . Follow-up Knowledge treatment effects of contingency management and motivational Skills interviewing on substance use: A meta-analysis . Psychology of Addictive Behaviors, 31, 403–414 .

Suchman, N ., DeCoste, C ,. McMahon, T ., Dalton, R ., Mayes, L ., & Borelli, J . Knowledge (2017) . Mothering from the inside out: Results of a second randomized Skills clinical trial testing a mentalization-based intervention for mothers in addiction treatment . Development and Psychopathology, 29, 617–636 .

Susukida, R ., Crum, R . M ,. Stuart, E . A ., & Mojtabai, R . (2018) . Knowledge Generalizability of the findings from a randomized controlled trial of a Skills web-based substance use disorder intervention . American Journal on Addictions, 27, 231–237 .

Szott, K . (2015) . Contingencies of the will: Uses of harm reduction and the Knowledge disease model of addiction among health care practitioners . Health, 19, Values 507–522 . Cognitive and Affective Processes

Thorens, G ., Schab, S ., Rothen, S ,. Khaazal, Y ., & Zulllino, D . (2014) . Harm Knowledge reduction in non-substance related addictions . Alcohol and Alcoholism, Skills 49(suppl 1), i11 .

Vakharia, S ., & Little, J . (2017) . Starting where the client is: Harm reduction Knowledge guidelines for clinical social work practice . Clinical Social Work Journal, Skills 45, 65–76 .

Wimberly, A . S ., Engstrom, M ., Layde, M ., & McKay, J . R . (2018) . A Knowledge randomized trial of yoga for stress and substance use among people Skills living with HIV in reentry . Journal of Substance Abuse Treatment, 94, 97–104.

Winters, K . C ., Tanner-Smith, E . E ., Bresani, E ., & Meyers, K . (2014) . Current Knowledge advances in the treatment of adolescent drug use . Adolescent Health, Skills Medicine, and Therapeutics, 5, 199–210 .

Woody, G . E . (2017) . Advances in the treatment of opioid use disorders . Knowledge F1000 Research, 6, 87 . doi:10 12688/f1000research. 10184. 1. . https:// Skills www .ncbi .nlm .nih .gov/pmc/articles/PMC5288680/

(continued) Competency 8: Intervene With Individuals, Families, Groups, Organizations, and Communities 113

Readings (continued)

Resource Competency Dimension

Yates, P . (2014) . San Patrignano: A narrative approach to substance Knowledge abuse treatment . Journal of Social Work Practice in the Addictions, 14, Skills 435–440 .

Young, L . B . (2011) . Hitting bottom: Help seeking among Alcoholics Knowledge Anonymous members . Journal of Social Work Practice in the Addictions, Values 11, 321–335 . Cognitive and Affective Processes

BOOK CHAPTERS

Morrison, J . A . Berenz, E . C ., & Coffey, S . F . (2014) . Exposure-based Knowledge trauma-focused treatment for comorbid PTSD-SUD . In P . Ouimette & Skills J . P . Read (Eds .), Trauma and substance abuse: Causes, consequences, treatment of comorbid disorders (2nd ed ., pp . 253–279) . American Psychological Association .

Najavits, L . M . (2014) . Creating change: A new past-focused model for Knowledge trauma and substance abuse . In P . Ouimette & J . P . Read (Eds .), Trauma Skills and substance abuse: Causes, consequences, treatment of comorbid disorders (2nd ed ., pp . 281–303) . American Psychological Association .

Olsen, Y ., & Sharfstein, J . M . (2019) . Treatment and recovery policy for the Knowledge opioid epidemic . In The opioid epidemic: What everyone needs to know Values (pp . 67–96) . Oxford University Press . Cognitive and Affective Processes

Olsen, Y ., & Sharfstein, J . M . (2019) . Treatment for opioid addiction . In The Knowledge opioid epidemic: What everyone needs to know (pp . 171–189) . Oxford Values University Press . Cognitive and Affective Processes

U .S . Department of Health and Human Services (HHS), Office of the Knowledge Surgeon General . (2016, November) . Facing addiction in America: The Values Surgeon General’s report on alcohol, drugs, and health . Author . Chapter 3, Prevention Programs and Policies . Appendix B, Evidence-based Skills Prevention Programs and Policies . Cognitive and Affective Processes

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Readings (continued)

Resource Competency Dimension

Winters, K . C ., et al . (2018) . Adolescent substance abuse treatment: A Knowledge review of evidence-based research . In C . Leukefeld & T . Gullotta (Eds .), Skills Adolescent substance abuse. Issues in children’s and families’ lives . Springer . Cognitive and Affective Processes

BOOKS

Denning, P ., & Little, J . (2012) . Practicing harm reduction psychotherapy: Knowledge An alternative approach to addictions (2nd ed .) . Guilford . Values Skills Cognitive and Affective Processes

Mee-Lee D ., Shulman, G . D ., Fishman, M . J ., Gastfriend, D . R ., & Miller, M . Knowledge M . (Eds .) . (2013) . The ASAM criteria: Treatment criteria for addictive, Skills substance-related, and co-occurring conditions (3rd ed .) . The Change Companies .

Miller, W . R ., Forcehimes, A . A ,. & Zweben, A . (2019) . Treating addiction: A Knowledge guide for professionals (2nd ed ). . Guilford . Values Skills Cognitive and Affective Processes

Miller, W . R ., & Rollnick, S . (2013) . Motivational interviewing: helping people Knowledge change (3rd ed .) . Guilford . Values Skills Cognitive and Affective Processes

Roth, J . D ., & White, W . L . (Eds .) . (2014) . Broadening the base of addiction Knowledge mutual support groups: Bringing theory and science to contemporary Values trends. Routledge . Skills

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Readings (continued)

Resource Competency Dimension

Straussner, S . L . (Ed .) . (2014) . Clinical work with substance abusing clients . Knowledge Guilford Press . Values Skills Cognitive and Affective Processes

Straussner, S . L . A ., & Fewell, C . H . (2011) . Children of substance abusing Knowledge parents: Dynamics and treatment. Springer . Values Skills Cognitive and Affective Processes

Sun, A . P . (2018) . Treating addictions: The four components . Routledge . Knowledge Values Skills Cognitive and Affective Processes

Van Wormer, K ., & Davis, D . R . (2018) . Addiction treatment: A strengths Knowledge perspective (4th ed ). . Cengage Learning . Values Skills Cognitive and Affective Processes

Velasquez, M . M ., Crouch, C ,. Stephens, N . S ., & DiClemente, C . C . (2016) . Knowledge Group treatment for substance abuse: A stages-of-change therapy Values manual (2nd ed .) . Guilford Press . Skills Cognitive and Affective Processes

Wiechelt, S . A ., & Straussner, L . (Eds ). . (2016) . Examining the relationship Knowledge between trauma and addiction . Routledge . Values Skills Cognitive and Affective Processes 116 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

Learning Activities Resource Competency Dimension

Identifying and Languaging Feelings Knowledge Students engage in an experiential exercise to learn how to teach clients Skills to identify their feelings and communicate their experience to others . Cognitive The ability to identify and language feelings is a skill necessary for and Affective participation in therapeutic processes and recovery work . Processes See Appendix 8A-1 .

Treatment Planning Knowledge Students learn how to develop a coherent, meaningful, and measurable Skills treatment plan for each client . Cognitive See Appendix 8A-2 . and Affective Processes

Motivational Interviewing Facilitation Knowledge Students practice and can demonstrate competence in the use of basic Skills motivational interviewing listening skills and techniques . Cognitive See Appendix 8A-3 . and Affective Processes

SBIRT Skills Practice Knowledge Student practice using the Screening, Brief Intervention, and Referral to Values Treatment (SBIRT) approach in role-plays using case vignettes . Skills See Appendix 8A-4 . Cognitive and Affective Processes

CBT Relapse Prevention Practice Knowledge Students practice using the CBT model for relapse prevention with clients Values who experience substance use problems or disorders via role plays with Skills other students by using case vignettes . Cognitive See Appendix 8A-5 . and Affective Processes

Harm Reduction Group Work Knowledge Students practice implementing a harm reduction group by engaging in Values role plays of groups of people who have substance use problems, with Skills one student in each group acting as the social worker facilitating the group . Cognitive and Affective See Appendix 8A-6 . Processes Competency 8: Intervene With Individuals, Families, Groups, Organizations, and Communities 117

Media Resource Competency Dimension MUTUAL AID GROUPS

Al-Anon Knowledge http://www .al-anon .org

Alcoholics Anonymous Knowledge http://www .aa .org

Nar-Anon Family Groups Knowledge https://www .nar-anon .org

Narcotics Anonymous Knowledge http://www .na .org

Secular Organizations for Sobriety Knowledge http://www .sossobriety .org

SMART Recovery Knowledge http://www .smartrecovery .org/

Women for Sobriety Knowledge https://womenforsobriety .org

GOVERNMENT WEBSITES

Drugs of Abuse (DEA) Knowledge https://www .dea .gov/documents/2017/06/15/drugs-abuse

National Institute on Alcohol Abuse and Alcoholism, Professional Knowledge Education Materials https://www .niaaa .nih .gov/publications/clinical-guides-and-manuals

National Institute on Drug Abuse, Resources for Medical & Health Knowledge Professionals http://www .nida .nih .gov

National Institute on Drug Abuse for Teens (games and activities) Knowledge https://teens .drugabuse .gov/

Substance Abuse and Mental Health Services Administration http://www . Knowledge samhsa .gov

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Media (continued)

Resource Competency Dimension

Office of Disease Prevention and Health Promotion, Healthy People Gov,. Knowledge Evidence-Based Resources https://www .healthypeople .gov/2020/topics-objectives/topic/ substance-abuse/ebrs

Substance Abuse and Mental Health Services Administration Co-occurring Knowledge Disorders http://www .samhsa .gov/co-occurring

INFORMATIONAL PAGES

Harm Reduction Coalition: Overdose Prevention Knowledge https://harmreduction .org/issues/overdose-prevention/

International Drug Policy Consortium Knowledge https://idpc .net/about

National Association for Children of Addiction Knowledge https://nacoa .org Skills

We Are the Drug Policy Alliance Knowledge http://www .drugpolicy .org

VIDEOS

Opiates and Evidence-based Treatment Success Knowledge https://www .pbs .org/wgbh/nova/video/addiction/

“Chasing Heroin,” PBS Frontline Special Knowledge https://www .pbs .org/wgbh/frontline/film/chasing-heroin/

Chasing the Dragon Documentary (FBI/DEA) Knowledge https://www .fbi .gov/video-repository/newss-chasing-the-dragon-the- life-of-an-opiate-addict/view

Webinar: Making the Connection: Homelessness and the Opioid Crisis Knowledge https://endhomelessness .org/resource/make-connection- Skills homelessness-opioid-crisis/

Motivational Interviewing (resources and video links) Knowledge https://motivationalinterviewing .org/motivational-interviewing- resources

(continued) Competency 8: Intervene With Individuals, Families, Groups, Organizations, and Communities 119

Media (continued)

Resource Competency Dimension

Motivational Interviewing Bad and Good Examples Knowledge https://www youtube. .com/watch?v=_VlvanBFkvI Skills https://www youtube. .com/watch?v=67I6g1I7Zao

Making a Place Called Safe: A Public Health Case for a Safer Injection Knowledge Facility in San Francisco, CA Values https://www youtube. .com/watch?time_continue=68&v=9yZ5Pd3ULbw

Mouse Party! (shows impact of various drugs on the brain) Knowledge https://illinois .pbslearningmedia .org/resource/lsps07 .sci .life gen. .mouseparty/mouse-party/# WSb4OEewfIU.

Preventing Prescription Drug Overdose Knowledge https://drogriporter .hu/en/how-to-prevent-prescription-drug- Values overdose-deaths/

Assignments Resource Competency Dimension

Mutual Aid Meeting Paper Knowledge Students attend a meeting of a mutual aid group and write a reflection Values paper that involves critical thinking and assessment of their own cognitive Skills and affective processes and pertinent literature . Students will also consider ways of referring clients to these programs . Cognitive and Affective See Appendix 8B-1 . Processes

Case Analysis Knowledge Students are provided a case to analyze along with a series of questions Values pertinent to social work practice with a client who has substance use Skills problems (e g. ., diagnosis, intervention, and treatment plan) . Cognitive See Appendix 8B-2 . and Affective Processes

Group Presentation on a Special Population Knowledge Student teams work together to develop a group presentation on a Values selected special population and needs and interventions specific to the Skills selected population . Cognitive See Appendix 8B-3 . and Affective Processes

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Assignments (continued)

Resource Competency Dimension

Group Facilitation Demonstration Knowledge Students will research, develop, and implement a group in the classroom Skills setting . Cognitive See Appendix 8B-4 . and Affective Processes

Motivational Interviewing Reflection Paper Knowledge Students will engage in motivational interviewing processes during Skills a client interview or interaction and write a paper reflecting on the Cognitive experience . and Affective See Appendix 8B-5 . Processes

Prevention Planning Assignment Knowledge Student will work together in groups to develop a prevention plan Skills for a community using the SAMHSA Strategic Planning Framework Cognitive (see https://ctb .ku .edu/en/table-of-contents/overview/models-for- and Affective community-health-and-development/strategic-prevention-framework/ Processes main) and present the plan to the class and write a paper on the plan . See Appendix 8B-6 .

Field Activities Resource Competency Dimension

Determine what approaches your field placement setting is using to Knowledge address substance use problems (e g. ,. abstinence based, harm reduction, Values trauma informed, trauma specific, CBT, 12-Step facilitation) . You can accomplish this by reading literature put out by the agency, such as Skills pamphlets, or mission statements; observing the interventions used by Cognitive clinicians; and having discussions with your field instructor . Consider the and Affective benefits and drawbacks of the approaches used and discuss them in your Processes field seminar .

Independently (under the supervision of your field instructor or task Knowledge supervisor) work with a client or client group to develop a relapse Skills prevention plan and teach them skills necessary to prevent relapse .

Identify evidence-based family interventions that would benefit clients Knowledge and their families where substance use is a problem in your agency Skills setting . Implement the intervention under the supervision of your field instructor .

(continued) Competency 8: Intervene With Individuals, Families, Groups, Organizations, and Communities 121

Field Activities (continued)

Resource Competency Dimension

Consider current drug policy and how it has affected or affects the client Knowledge population you are working with . Determine at least two ways you could Values advocate on behalf of the client populations . Discuss your ideas with your field instructor and in your field seminar . Skills Cognitive and Affective Processes

Research, develop, and implement a skill-based group that would benefit Knowledge your client population under the supervision of your field instructor (e g. ., Skills assertiveness, anger management, mindfulness) . Cognitive and Affective Processes

APPENDIX 8A-1: IDENTIFYING AND LANGUAGING FEELINGS Students engage in an experiential exercise to learn how to teach clients to identify their feelings and communicate their experience to others. In order to participate in many therapeutic approaches, people need to be able to identify and articulate their emotional experiences and reactions. One effect of this exercise is that it helps students recognize their own capacity for feeling identification and articulation. It also provides them with an opportunity to practice facilitating a skill-building group. Provide students with a “feeling grid” with cells for happy, sad, scared, and mad. Ask students to write in additional low-, medium-, and high-intensity feeling words under each category (e.g., “ecstatic” is a high-intensity feeling word under “happy”). Discuss the students’ experience filling out this grid. Provide them with a feeling grid that shows many feeling words (create your own or use an online resource, e.g., https://www.cnvc.org/sites/default/files/feelings_inventory_0.pdf). Be clear with the students that you would not give the blank grid to clients but rather would provide them with a complete feelings chart. Break up your class into groups of six to eight. Each group should pick one member to act as the social worker. Provide each group with a large doodle pad sheet or poster board and large magic marker. The group social worker draws a large blank grid on the sheet. They then ask the group members to call out feeling words and write 122 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE them on the grid. Once the grid is full of feeling words, the group members take turns flipping a quarter onto the grid. The group member who flipped the coin defines the feeling word that the coin lands on and describes what the feeling is like (e.g., where you experience it in your body and what happens). They should also provide an example of a time that they experienced the feeling. Other group members can provide help if any member has difficulty defining the feeling word, describing the feeling experience, or providing an example.

APPENDIX 8A-2: TREATMENT PLANNING The goal of the exercise is to help students learn how to develop a coherent, meaningful, and measurable treatment plan for each client. Divide the class into smaller groups (four or five students per group). Distribute copies of an identical case scenario—a client who has multiple problems or needs, including an SUD or substance use problem—to each student. Each group will take 40 minutes to discuss the case and come up with a treatment plan. For the treatment plan, each group will identify and prioritize three major problems or needs of the client, develop corresponding treatment goals and objectives, and list various intervention strategies or actions to achieve each goal. Each group will then send a representative to write its treatment plan on the whiteboard or blackboard. Alternatively, the exercise can be completed by the student groups on a computer and shown on screen with a projector or sharing software. The instructor and the entire class will review, evaluate, and discuss the quality (merits and room for improvement) of the treatment plan developed by each group.

APPENDIX 8A-3: MOTIVATIONAL INTERVIEWING FACILITATION The purpose of this exercise is to provide students with an opportunity to practice and demonstrate competence in the use of motivational interviewing (MI) basic listening skills and techniques. Divide the students into groups of three. Each group of students will construct and facilitate sample client interviews from a variety of clinical and nonclinical settings (students may use Competency 8: Intervene With Individuals, Families, Groups, Organizations, and Communities 123 a case from their own experiences in the field, or the instructor can provide case vignettes). Each student in the group will take a turn serving as client, facilitator, and observer. Each interview will include the use of at least three basic MI listening skills (i.e., open-ended questions, affirm, reflective listening, or summarize) and one MI technique (i.e., asking permission, eliciting change talk, exploring importance, normalizing, decisional balance, supporting self-efficacy, readiness to change ruler, or advice/feedback). After each interview the observer will provide feedback to the facilitator on their use of MI, and all three group members will discuss their experience and observations

APPENDIX 8A-4: SBIRT SKILLS PRACTICE The purpose of this exercise is to build knowledge and skills for using the SBIRT approach with clients in a variety of practice settings to identify and address risky or problematic substance use. To begin the exercise, review the components of SBIRT (see https://www.masbirt.org/sites/www.masbirt.org/files/documents/toolkit.pdf). Break up the class into groups of three (clinician, client, and observer). Provide the students with at least three brief vignettes. Each student in each group will take turns in the roles of social worker, student, and observer. The observer should particularly watch for the social worker’s adherence to the SBIRT model and be prepared to provide constructive feedback. At the end of each role play, the three group members should discuss their experience in the role play and the observations noted by the observer. After all, students have an opportunity to practice SBIRT in each role, reconvene the class, and hold a full class discussion of the experience and students’ ideas about how SBIRT is consistent with social work values and practice methods.

APPENDIX 8A-5: CBT RELAPSE PREVENTION PRACTICE The purposes of this exercise are for students to gain knowledge about CBT- informed relapse prevention strategies with clients who experience substance use problems or disorders and to develop skill for implementing the strategies with clients. Review CBT-informed relapse prevention strategies with the class (see https://pubs.niaaa.nih.gov/publications/arh23-2/151-160.pdf). Then divide 124 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE students into pairs and have each pair of students take turns in the role of the social worker and the client. Provide the students with case vignettes to use as a basis for the client role. The student in the social worker role should work with the student in the client role to develop a relapse prevention plan (i.e., identify triggers and high-risk situations and develop a plan for coping with them). Select one of the high-risk situations identified and work with the client to develop self-efficacy using a skill training strategy (i.e., modeling, practicing skill, feedback, and “homework”). After the students have completed their role plays, hold a class discussion on their experiences in the role play, lessons, learned, and ideas on how well the CBT approach for relapse prevention is consistent with social work values.

APPENDIX 8A-6: HARM REDUCTION GROUP WORK The purposes of this assignment are for students to gain knowledge about a harm reduction–based group intervention for people who have substance use problems or disorders and practice skills facilitating such a group. Review the harm reduction group approach (see https://harmreductiontherapy.org/ wp-content/uploads/2014/11/Harm-Reduction-Groups.pdf). Divide the class into groups of six to eight and ask each group to select a group facilitator. The group members should take on roles of clients with substance use problems or disorders. Allot enough time for the groups to practice and still leave time for whole class discussion considering the length of your class period. Reconvene the class and discuss the students’ thoughts and feelings about the group practice, highlighting the utility of harm reduction approaches for serving populations of those who experience substance use problems and the application of harm reduction in group work with this population. Also discuss how well harm reduction group work comports with social work ethics and values.

APPENDIX 8B-1: MUTUAL AID MEETING ASSIGNMENT Choose a mutual aid program for people who have substance use problems or are family members of people who have substance use problems (not one that you are a member of) (e.g., Alcoholics Anonymous, Al-Anon, SMART Competency 8: Intervene With Individuals, Families, Groups, Organizations, and Communities 125

Recovery). Attend an open meeting of the group. Meetings can be identified through online sources, schedule pamphlets, and other sources. Note any special instructions for attending a meeting. Identify three peer-reviewed articles pertinent to the type of meeting you attended. You may use additional peer-reviewed or non–peer-reviewed sources as well.

● Arrive at least 15 minutes before the meeting starts.

● Go to the meeting alone or with one other student (more than that may make group members feel uncomfortable).

● Identify yourself as “a social work student here to learn” about the group.

● Turn off or silence your devices (e.g., phones, watches). Do not text, look at your device, or use your device in any way during the meeting.

● Remain attentive and respectful throughout the meeting (note taking or whispering to others will be viewed as disrespectful).

● Keep the identity of anyone you see at the meeting confidential.

Write a brief (3- to 5-page) paper that includes the following:

● Statement of the type of meeting you attended, location, and time.

● Discussion drawing on the literature you selected about the nature and value of the program you attended (e.g., AA, NA, SMART Recovery) and the specific aspects of the program that are beneficial to people.

● Description of how you identified a meeting to attend and any challenges, thoughts, and feelings you experienced during the process.

● Description of your experience at the meeting (arrival, greeting, interactions, thoughts, feelings, and reactions you had).

● Description of the meeting process (do not disclose anyone’s name).

● Discussion of how you think the program affects members and their substance use behaviors.

● Description of your reactions to the meeting.

● Descriptions of any new awareness you gained by attending the meeting. 126 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

● Discussion of how you would refer a client to this program, help them identify a meeting, and prepare them for attending their first meeting.

APPENDIX 8B-2: CASE ANALYSIS Using the case vignette provided, respond to each item below.

1) Considering the case history, write a brief paragraph that describes the client’s issues as they relate to or support the diagnosis of an SUD. Identify the level of severity rating for the SUD that you think fits the client.

2) Write a list of the client’s needs and problems. Explain your rationale for each need or problem you identify.

3) Write a list of the client’s strengths.

4) Considering the client’s status on diversity (gender, race and ethnicity, religion), discuss any impacts on the addictive process, progression, recovery.

5) Write a list of recommendations for the client.

6) What level of care do you think the client needs for treatment (outpatient group, intensive outpatient, partial hospitalization, inpatient, residential)? If you think detoxification is needed, list that, but also add subsequent or simultaneous treatment. Explain your rationale for the selected level of care.

7) What therapeutic approach or combination of approaches would best help the client in the level of care you suggest (e.g., cognitive–behavioral, 12-Step facilitation, trauma-informed, integrated trauma and substance abuse treatment)? Explain why the approach or approaches would be best in this case. What theory or theories related to the etiology of addiction underlie the treatment approach?

8) Identify a treatment goal and list objectives for that goal. List specific interventions that would help the client to achieve the goals (e.g., psychoeducation group, individual sessions, family sessions). Competency 8: Intervene With Individuals, Families, Groups, Organizations, and Communities 127

9) Should the client’s family be engaged in treatment? How? What type of treatment? Why?

10) Define relapse and relapse prevention. What strategies should be used to help the client prevent relapse?

APPENDIX 8B-3: GROUP PRESENTATION ON A SPECIAL POPULATION Divide into groups of four or five members. Each group is responsible for developing a presentation on a special population. A list of possible special populations to focus on will be provided to you, and each group will select a population from the list. If two or more groups want the same population, the group for that population will be randomly selected in a class discussion of the assignment. Each presentation should last 1.25 hours (including time for questions at the end). During your presentation you should define and describe the population and particular issues regarding the etiology, course, and treatment (assessment, modalities, particular concerns, effective interventions) of SUDs or substance misuse in the group. Your presentation should reflect current knowledge on your topic area. You may use chapters in our textbook, books, journal articles, and Internet resources. Verify that any Internet sources you use are reliable (i.e., developed by a reputable source). You may divide your work between group members in a variety of ways (e.g., literature search, presentation materials, verbal presentation). You may consult with the professor on your presentation plan. You may use PowerPoint slides or videos, weblinks, and so on. You will be graded on the following:

● Quality of presentation materials (e.g., slides, handouts)

● Thoroughness of content covered relative to the topic

● Use of resources with appropriate citation (can be done on bottom of slide, reference slide, or slide handout)

● Quality of presentation delivery (holds audience’s attention, engages audience, coordination between presenters apparent, rate and volume of speech appropriate). 128 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

APPENDIX 8B-4: GROUP FACILITATION DEMONSTRATION For this assignment you and a co-facilitator (should you choose to have one) will design and implement a 20- to 30-minute group for the class. The group can be skill-based, psychoeducation, or therapeutic (e.g., session from a manualized program, process group). Considering the type of session you plan to demonstrate, recruit a group of your fellow students or the entire class to be your group members. Inform your group members which client population in what setting they are representing (e.g., adolescents in an intensive outpatient program). For groups that do not involve the entire class as group members, we will use a fishbowl approach (i.e. the active group will sit in a circle in the middle and the observing class members will sit in a circle around them).

When you are finished with the group:

● Ask participating members what they experienced during the group.

● Ask observers what they saw happening in the group.

● Explain the specific goals, strategies, and techniques you demonstrated in the group.

● Obtain feedback from the group members and observers on how well you accomplished your goals and implemented the strategies and techniques.

APPENDIX 8B-5: MOTIVATIONAL INTERVIEWING REFLECTION PAPER The purpose of this paper is to demonstrate use of at least one of the four motivational interviewing (MI) processes during a client interview or interaction and to reflect on the experience. You will select a client interview or interaction from your field placement or place of employment. During the interview or interaction, you will practice use of at least one MI process. After the interview or interaction you will record the client conversation on the process recording sheet. You will then examine the conversation and reflect on your interaction, technique, and skill ability. Competency 8: Intervene With Individuals, Families, Groups, Organizations, and Communities 129

Your paper should include the following:

● A brief description of the placement or employment setting and types of clients served by the agency

● A brief description of the client selected for this paper (e.g., age, gender, services received, purpose of interaction) and of the interview or interaction

● A general description of the four MI processes, as well as a detailed description (the purpose, when and how) of at least one specific process you used during the interview

● A summary of your reaction or reflection on using the technique and your skill, benefits, and challenges to using the technique

● A sample of the process recording demonstrating use of at least one of the four MI processes

APPENDIX 8B-6: PREVENTION PROGRAM PLANNING This is group assignment includes both a presentation and a paper. The detailed description for each is provided below.

Presentation

A community (to be assigned) has just hired you to initiate a substance abuse prevention program. In groups of four you will use SAMHSA’s Strategic Prevention Planning Framework to design a prevention program. You will present your program to “the community” (your class) in a 30-minute PowerPoint presentation on the date you are assigned. Include attention to the following:

● Community description (e.g., epidemiology, culture), with relevant graphs or charts

● Needs assessment (e.g., nature and extent of substance use problems, risks and protective factors, current efforts to address problem)

● Building capacity (e.g., community readiness, potential resources, including ideas for gaining more resources, potential community partners, key stakeholders) 130 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

● Planning (e.g., prioritizing issues, designing logic model, exploration of evidence-based treatment models)

● Intervention (e.g., describe chosen evidence-based intervention, developmental appropriateness, potential strengths and limitations, cultural and ethical considerations)

● Evaluation (e.g., describe your evaluation plan, including any pre/post assessment measures or surveys)

Paper

Prepare a paper related to your assigned prevention program. The paper should be written in APA format and be approximately 5–10 pages in length. You are required to:

● Summarize theories of addiction and addictive behaviors.

● Describe theories of substance abuse prevention, including attention to risk and protective factors.

● Present your prevention program using the outline provided for your group presentation above (e.g., community description, needs assessment).

● Reflect on salient points of learning and insight achieved from completing this project.

Community Vignettes for Prevention Assignment Spring Valley Spring Valley, an ethnically and culturally diverse community, is located in a large northwestern metropolitan area. Each year, approximately 25% of the community relocates elsewhere. Approximately 25% of Spring Valley adults have less than a sixth-grade education, 45% have finished the twelfth grade, and 30% have college degrees. Spring Valley parents and caregivers work long hours. Most adults have full- or part-time jobs, with average annual incomes ranging from $15,000 to $60,000. Competency 8: Intervene With Individuals, Families, Groups, Organizations, and Communities 131

Many Spring Valley parents, some of whom many are single, meet weekly at the community center for salad and dessert. On the weekends, Spring Valley adults participate in soccer games and attend other recreational and social events at the community center, which has a liberal alcohol use policy. Three spiritual communities—St. Mark’s, the Faith Assembly of Christ, and the Calvary–Casa del Pueblo United Methodist Church—serve Spring Valley and the surrounding area. Each conducts several bilingual services, and two congregations offer English as a Second Language programs. Local businesses actively support the community. C&S Enterprises, a local computer firm, is working with the Spring Valley Chamber of Commerce to gain support for First Night, a family-oriented alcohol-free New Year’s celebra- tion. Parents and local businesses have worked together to provide Internet access for local schools, to renovate the community’s daycare facility, and to post bilingual signs in many local businesses. Spring Valley also enjoys support from individual community residents. A local pharmacist recently realized that many of his customers, particularly retirees and immigrant families with young children, were not always following directions on prescription medications. He is working with several of the public schools and the area’s retirement home to develop a bilingual education program that will be offered throughout the year as part of various community functions. Still, there are several vacancies on the boards of the three spiritual communities, and several seats on the community center board remain unfilled.

Loganville Loganville is a rural frontier community of 15,000 residents. Until recently, Loganville’s population was mostly lower-middle class, but there has been an influx of upper-middle-class professionals, drawn to the area because of its proximity to scenic Lake Thoa. Typically, both parents work outside the home, resulting in less parental supervision of the community’s school-aged children. Most professionals com- mute to jobs in the metropolitan area, some distance away. Parents tend to be active in local politics and schools, especially with regard to budgets. The community’s twenty-one churches represent diverse faith traditions and are well attended. 132 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

Most residents subscribe to The Herald and The Review, daily newspapers from nearby cities. Television and radio programs are also feeds from regional metropolitan stations. Approximately fifty small businesses compose Loganville’s business district, which includes bars and stores where beer, wine, liquor, and tobacco products can be easily purchased, even by those younger than 21. The local weekly newspaper, The Independence, frequently carries articles on alcohol, tobacco, and other drug abuse, and these issues are often discussed at board of education and town council meetings. Long-time residents of Loganville and newer residents do not necessarily agree about these issues. Approximately 3,000 students attend the township’s public schools; another 1,000 students are enrolled in the local parochial school. Another 600 students attend the county vocational-technical school. Students are dis- missed much earlier than most parents return home from work. Many of the community’s teenagers have access to cars or pickup trucks and commonly report that “there is nothing to do in Loganville.” Loganville Public High School has an enrollment of 700 students, 70% of whom are white. African American, Asian American, and a small number of Hispanic American students compose the remainder. Approximately 60% of graduates go on to 4-year or community colleges. High school sporting events are well supported by the community. Alcohol use is accepted as normal, even for teenagers. The children of lower-middle-class residents often smoke cigarettes, as do their parents. The children of upper-middle-class professionals tend not to smoke, although some local officials have noted a slight increase in smoking in this group. These parents attribute this change to the influence of the “poor” kids. The prevalence of other drug use is moderate.

Silver City Silver City is a western community of approximately 50,000 residents sur- rounded by farms and ranches. Two major interstate highways intersect in Silver City and connect to an international border and a seaport of entry. Downtown Silver City was redeveloped about 10 years ago and continues to remain clean, with little graffiti. Although Old Town and the rest of the downtown are mainly commercial, there are few large businesses and no major Competency 8: Intervene With Individuals, Families, Groups, Organizations, and Communities 133 community funders other than United Way. Two industries that hire locally are a call-in catalog center and an airline mileage program. For the past 2 years, minibuses have run between downtown and nearby residential areas. The limited number of residential units in the downtown area consists of apartment buildings, many of which are owned and operated by the U.S. Department of Housing and Urban Development. Because of Silver City’s proximity to several national parks, tourism is a seasonal source of business. To encourage visitors, Silver City sponsors a yearly rodeo, the Tri-County Fair, a summer stock show, and a motorcycle rally, all of which attract up to 500,000 people. Dingbat Brewing Company cosponsors these events, displaying event banners sporting the company logo and setting up beer tents separated from the family event area by portable fencing and controlled access. One large mall, accessible by car, has seventy stores, including two anchor stores: Sears and J.C. Penney. Part-time, seasonal employment is competitive among adults and young people alike. Silver City is large enough to support an airport, a bus depot, and a train station, all of which employ community residents and sponsor community events. There are two community colleges and one university, Mid-Western Technical University. Faculty and students participate in mentoring programs within Silver City’s public-school system. Silver City Memorial Hospital serves the western half of the state and operates a major trauma center. Based on a recent student survey, the Silver City public school system is reporting a small increase in drug use in grades six and eight. The survey also showed that students in grades eight, 10, and 12 had decreased perceptions of the harm of alcohol, tobacco, and marijuana use. It also revealed an increase in student truancy rates. In response, a small group of concerned parents is meeting to address these issues. The schools have an active program in which individual classes “adopt” a local business for one academic year. Most community members are Caucasians whose families have lived in the area for generations. The small Native American population remains isolated from community resources, maintaining links to its heritage by returning to the reservations at various times throughout the year. Most of the small number of African Americans live at the nearby Air Force base. The Jewish 134 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE community sponsors a homeless shelter, three soup kitchens, and a safe house for women and children who are victims of domestic violence. A second safe house recently opened and operates at capacity. In a recent radio interview, the director of Silver City’s Head Start program described the local gang population as “wannabes.” She remarked that gang members primarily walk around the downtown area in groups. Local police are concerned about increasing petty crime and drug arrests, and local businesses have reported a decrease in business over the last 2 years. Silver City’s substance abuse problems have been related primarily to marijuana, alcohol, and speed. Crack cocaine and other substances found in large urban areas have not become common in Silver City. Competency 9 Evaluate Practice With Individuals, Families, Groups, Organizations, and Communities

COMPETENCY DESCRIPTION Social workers working with substance use employ evidence-based practices with individuals, families, groups, organizations, and communities to support people affected by unhealthy substance use and associated risk behaviors. Evaluation of practice is ethical, collaborative, interdisciplinary, and strengths- based. It involves and empowers all clients and constituents as contributors to the evaluation process. Barriers to treatment often overwhelm individuals, agencies, and communities who need substance use services. Social workers adapt evaluation research designs and measurement tools to include client systems across many practice settings. They advocate for and encourage the effective implementation and funding of best practices, rigorous evaluation processes, and affirming policies. Quantitative and qualitative methods are culturally and developmentally responsive and targeted to individuals, families, groups, organizations, and communities. Validated measures are used to gather data, evaluate processes and outcomes, and increase the efficacy, effectiveness, and fidelity of practice at all levels. Social workers communicate and disseminate evaluation findings across micro, mezzo, and macro levels of practice to improve value and quality of services.

PRACTICE COMPETENCY BEHAVIORS

● Identify and use appropriate evaluation methods to measure practice processes and outcomes with individuals, families, groups, organizations, and communities and advocate to discontinue ineffective practices, programs, and policies.

135 136 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

● Plan, conduct, and participate in research and evaluation to continuously improve practices, programs, and policies affecting unhealthy substance use and associated risk behaviors among clients and constituents.

● Apply evaluation processes and outcomes to inform measurement-based care, continuous quality improvement, fidelity monitoring, supervision, and innovation to support those challenged by unhealthy substance use and associated risk behaviors across practice settings.

● Translate and disseminate research and evaluation outcomes to increase efficacy, monitor effectiveness, confirm fidelity, and promote sustainability of evidence-based substance use practices, programs, and policies.

CURRICULAR RESOURCES MAPPED TO COMPETENCY DIMENSIONS

Readings Resource Competency Dimension

Butler, S ., Wardamasky, S ., & Brennan-Ing, M . (2012) . Older women caring Knowledge for older women: The rewards and challenges of the home care aide Values job . Journal of Women & Aging, 24(3), 194–215 . Cognitive and Affective Processes

Hamilton, J . D ., & Bickman, L . (2008) . A measurement feedback system Knowledge (MFS) is necessary to improve mental health outcomes . Journal of the Values American Academy of Child & Adolescent Psychiatry, 47, 1114–1119 .

Miller, S . D ., Hubble, M . A ,. Chow, D ., & Seidel, J . (2015) . Beyond measures Knowledge and monitoring: Realizing the potential of feedback-informed Values treatment . Psychotherapy, 52, 449–457 .

Trauer, T ., Gill, L ., Pedwell, G ,. & Slattery, P . (2006) . Routine outcome Knowledge measurement in public mental health: What do clinicians think? Australian Health Review, 30(2), 144–147 .

United Nations Office for Drugs and Crimes . (2015) . Evaluation of Knowledge substance use treatment programmes . https://www .unodc .org/ Skills documents/islamicrepublicofiran/publications/1jan2015/Evaluation_ of_Substance_Use_Treatment_Programmes-EN .pdf

(continued) Competency 9: Evaluate Practice With Individuals, Families, Groups, Organizations, and Communities 137

Readings (continued)

Resource Competency Dimension

Web Resource Knowledge Rural Prevention and Treatment of Substance Use Disorders Toolkit Skills https://www .ruralhealthinfo .org/toolkits/substance-abuse/5/ evaluation-measures

Learning Activities Resource Competency Dimension

Lesbian, Gay, Bisexual, or Transgender (LGBT) Older Adults Teaching Knowledge Module Values https://cswe .org/getattachment/Centers-Initiatives/Centers/Gero-Ed- Skills Center/SocialWorkPracticeandCompetencywithLGBTOlderAdults_2015_ TeachingModule .docx .aspxh The instructor provides content from this module on the challenges facing older LGBT people and their strengths and resilience in the face of adversity, and it reviews the professional competencies for working with this population . Three cases can be used as class exercises: Case of Ellen, Case of Charles, and Case of Elizabeth . See Appendix 9A .

Feedback-informed Treatment: Outcome Rating Scale and Session Knowledge Rating Scale Values Objective: Practice receiving real-time evaluative feedback as part of your Skills work with a client . To complete this assignment: a . Familiarize yourself with the Feedback Informed Treatment Outcome Rating Scale (ORS) and Session Rating Scale (SRS) forms and the technique for recording the scores on a graph . b . With a colleague, role play as both clinician and client introducing the ORS and SRS . Be sure to approximate the developer’s example of introducing the instruments . c . Role play later sessions and use the graph to discuss trends in the ORS and SRS . d . For copies of the ORS and SRS, see https://scott-d-miller-ph-d . myshopify .com/collections/performance-metrics/products/ performance-metrics-licenses-for-the-ors-and-srs 138 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

Media Resource Competency Dimension

GenSilent (2010) Knowledge http://gensilent .com Values This documentary interviews six older LGBT people about their fears Cognitive about accessing formal care as a sexual or gender minority . and Affective Discussion topics are available on the website . Processes

FEEDBACK-INFORMED TREATMENT: VIDEOS

“Feedback Informed Therapy” (3 08. minutes) Knowledge https://www youtube. .com/watch?v=hpRWMutOy08

“Feedback Informed Treatment: Social Construction Meets Evidence Knowledge Based Practice” (3 .56 minutes) https://www youtube. .com/watch?v=fYqiLaeMKG4

International Center for Clinical Excellence (ICCE) Knowledge “Feedback Informed Treatment” (7 14. minutes) https://www youtube. .com/watch?v=coODgxXXrZU

Assignments Resource Competency Dimension

Ethnogeriatrics Group Assignment Knowledge https://cswe .org/CMSPages/GetFile .aspx?guid=5577b98a-f534-46f9- Values b560-e9ad58bb7693h Skills Students engage in a semester-long assignment focusing on ethnogeriatrics, which is the intersection of ethnicity, aging, and health, and it includes health care for older adults from diverse ethnic populations . Description and instructions can be found by searching for the assignment title at the link provided . Competency 9: Evaluate Practice With Individuals, Families, Groups, Organizations, and Communities 139

APPENDIX 9A: LESBIAN, GAY, BISEXUAL, OR TRANSGENDER (LGBT) OLDER ADULTS TEACHING MODULE

The Case of Ellen Ellen is a 62-year-old Caucasian woman who is retired and holds an associate’s degree in business. In the recent past she served as the primary caregiver for her friend Judy. She uses the term friend as she has used it most of her life and explains that “partner is more of an eighties and nineties word.” Judy suffered from several heart and vascular conditions for which Ellen provided care “on and off for her for 25 years.” During that time, Ellen remembers constantly run- ning to the emergency room in the middle of the night while trying to maintain her full-time job. She states, “I had an office job during the day and a nursing job at night”; she did not receive any help from Judy’s family and did not feel comfortable talking to co-workers about having a significant other who was ill. In terms of her interactions with medical professionals, Ellen felt that these professionals were always looking around for Judy’s “husband, sister, or mother.” In attempts to be recognized by the doctors, Ellen would say things like, “I’m her best friend” or “she lives with me.” Judy always avoided setting up advance directives, and Ellen claims that she herself has always been far too independent to have joint property or bank accounts. After one hospital stay, Judy recovered at her daughter’s home. It was then decided that Judy needed 24-hour care and that it was best for Judy to remain at her daughter’s home. The move was “tough” on Ellen, and she claims that she got through it with the help of her friends (a female couple). Although sexual orientation was an “untouchable” subject in her family, Ellen’s sister recognized that she was suffering the loss of her friend of 25 years. After Judy’s relocation, it took Ellen a year to get back on her feet and feel comfortable in her home again without Judy’s presence. She also got “tired of being a third wheel” in her group of friends and often felt lonely and isolated. She began to see a therapist and describes the therapist as a “strong point” in her transition from the caregiving role. Initially, she admits that she had a lot of “squeamish- ness” about going to a therapist and thought “there is nothing wrong with my mind.” With the encouragement of her therapist, she “got a life” and learned about the gay community. She is now in a relationship with a woman 10 years 140 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE her junior, is taking much better care of herself, and is a “much happier person.” She visits Judy occasionally, but she often finds it upsetting because “she is just not taking care of herself.”

Questions for Discussion

● What are the common issues faced by Ellen and other caregivers?

● What are the special issues faced in caregiving by Ellen and other LGBT caregivers?

● What can social workers and other professionals and organizations do to support LGBT caregivers?

Source: Hash, K. M., & Rogers, A. (2013). Clinical practice with older LGBT clients: Overcoming lifelong stigma through strength and resilience. Clinical Social Work Journal, 41(3), 249–257.

The Case of Charles Charles is a 74-year-old African American transgender person. Charles was born female but identifies as male. He does not refer to himself as a trans- sexual and is nonoperative, meaning he has not undergone surgery to alter any biological sex characteristics. He reports that from an early age he felt “trapped” in the wrong body and would often sneak into his brother’s closet and secretly try on his clothes and underwear. He would also lock the bath- room door and practice urinating while standing up. His parents thought he was just a “tomboy” and thought would start acting more like a girl during his teenage years. They insisted on putting him in dresses, despite his resistance. During puberty Charles became very depressed. The physical changes were a constant reminder of the inconsistency between his developing female body and his male gender identity. He contemplated suicide but could not bring himself to attempt it because of his religious upbringing and beliefs. After graduating from high school, Charles moved to a larger city to start a new life where he could finally live as a man. He legally changed his name and began to dress as a man full-time. His family knew of these changes but still referred to him by his birth name and biological sex. Even though he has never consistently taken hormones, he says he can “pass” as a man in most situations, is happy, and feels comfortable in his own skin. After being outed Competency 9: Evaluate Practice With Individuals, Families, Groups, Organizations, and Communities 141 by co-workers in his job at a factory, he found work in gay and lesbian bars and bookstores. Although the wages were low, he felt accepted and at home in these settings and made many long-time friends. He dated several women and “even lived with a few” before meeting his girlfriend of 22 years, Gina. The couple currently lives in a subsidized apartment complex and often has difficulty paying bills. Charles confesses that his relationship with Gina has always been “fiery” and that their fights become physical at times. Lately their arguments have become more frequent and are escalating in terms of violence on the part of Gina. He has told Gina that it may be better if they lived apart, and he even applied for his own apartment in the same building. Each time he brings this up, she threatens to tell the whole apartment building that he is really a woman. This concerns him, because since they have been together he has had decreasing contact with friends and family. He has heard about a local LGBT organization that specializes in providing services to older members of the community. When Gina leaves to shop for groceries, Charles calls the organization to discuss alternative housing options.

Questions for Discussion

● What are the special issues in aging faced by Charles and other LGBT people?

● In what ways are Charles and other older transgender people at even greater risk for poor treatment by loved ones and professionals?

● If you were the social worker at the LGBT organization, what would you say to Charles when he calls?

Source: Hash, K. M., & Rogers, A. (2013). Clinical practice with older LGBT clients: Overcoming lifelong stigma through strength and resilience. Clinical Social Work Journal, 41(3), 249–257.

The Case of Elizabeth Elizabeth is a 60-year-old African American woman. She is employed as a nurse at a large for-profit nursing home facility in a small community in the southeastern United States. She has been with the organization for almost 10 years and is considered compassionate and reliable by the nursing home staff. 142 SPECIALIZED PRACTICE CURRICULAR GUIDE FOR SUBSTANCE USE SOCIAL WORK PRACTICE

Although she appears to be single, it is rumored among the facility that her “roommate” and she “are queer together.” In the past few months she has called in sick on several occasions and has used the majority of her vacation leave. Lately, she also appears exhausted and stressed on the job. Jane, a social worker in the nursing home, approaches Elizabeth and mentions her concern that she appears very stressed and asks whether there is anything she would like to talk about. Elizabeth reveals that she is dealing with a very difficult personal situation; specifically, her partner of 15 years, Teresa, is experiencing serious health problems. These problems have required that Elizabeth travel with Teresa to several medical appointments and provide hands-on care at home. Although Teresa’s mother and sister have been helping, they are not comfortable with the same-sex relationship, and their interactions are often strained. Elizabeth shares her concern with the social worker that she is the “sole breadwinner” of the household and does not want to risk losing her job by taking so much time off. She is tired of hiding the situation and of “burning up” all her vacation time. She also feels drained from having to “build excuses” for why she must take time off, such as “I have personal business to take care of” or “My best friend is ill and her mother needs someone to help take care of her.” She shares with the social worker her inclination to explain her difficult circumstances to her other co-workers and the administration, but she fears that her relationship will not be accepted, and her situation will not be supported.

Questions for Discussion

● What are the distinctive issues faced by Elizabeth and members of this population in society and in the workplace?

● If Elizabeth decides to come out in the workplace, what are some of the attitudes and behaviors that may surface among her co-workers or administrators?

● How can the agency and its staff support Elizabeth and other LGBT employees? Competency 9: Evaluate Practice With Individuals, Families, Groups, Organizations, and Communities 143

● What can be done at the larger policy levels (state, federal) to support LGBT people in the workplace? What can you do at your own university, field agency, or place of employment?

Source: Hash, K. M. (2006). Building excuses in the workplace. In L. Messigner & D. F. Morrow (Eds.), Case studies on sexual orientation and gender expression in social work practice (pp. 95–96). Columbia University Press.